| |
18907 Nordhoff St. #42 Northridge CA 91324-3794 | |
(818) 349-4956 | |
(818) 772-4942 |
Full Name | |
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Speciality | Dentist - Oral And Maxillofacial Pathology |
Location | 18907 Nordhoff St. #42, Northridge, California |
Authorized Official Name and Position | Jason Warren Pair (OWNER) |
Authorized Official Contact | 8183494956 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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18907 Nordhoff St. #42 Northridge CA 91324-3794 Ph: (818) 349-4956 | 18907 Nordhoff St. #42 Northridge CA 91324-3794 Ph: (818) 349-4956 |
NPI Number | 1366928509 |
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Provider Enumeration Date | 07/11/2018 |
Last Update Date | 03/05/2019 |
Identifier | Type | State | Issuer |
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1366928509 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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1223P0106X | Dentist - Oral And Maxillofacial Pathology | DDS44622 (California) | Primary |
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