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12660 Riverside Dr Suite 330 North Hollywood CA 91607-3429 | |
(818) 980-2647 | |
(818) 980-8901 |
Full Name | |
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Speciality | Clinic/center - Dental |
Location | 12660 Riverside Dr, North Hollywood, California |
Authorized Official Name and Position | Jerome Chua (OFFICE MANAGER) |
Authorized Official Contact | 8189802647 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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12660 Riverside Dr Suite 330 North Hollywood CA 91607-3429 Ph: (818) 980-2647 | 12660 Riverside Dr Suite 330 North Hollywood CA 91607-3429 Ph: (818) 980-2647 |
NPI Number | 1629235239 |
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Provider Enumeration Date | 05/21/2008 |
Last Update Date | 05/21/2008 |
Identifier | Type | State | Issuer |
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1629235239 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QD0000X | Clinic/center - Dental | 37076 (California) | Primary |
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