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4644 Lincoln Blvd Ste 404 Marina Del Rey CA 90292-6380 | |
| (310) 578-2500 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 4644 Lincoln Blvd Ste 404, Marina Del Rey, California |
| Authorized Official Name and Position | Vadim Konviser (CEO) |
| Authorized Official Contact | 3105782500 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
4644 Lincoln Blvd Ste 404 Marina Del Rey CA 90292-6380 Ph: (310) 578-2500 | 4644 Lincoln Blvd Ste 404 Marina Del Rey CA 90292-6380 Ph: (310) 578-2500 |
| NPI Number | 1831670637 |
|---|---|
| Provider Enumeration Date | 08/28/2018 |
| Last Update Date | 08/28/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831670637 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 51095 (California) | Primary |
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