| Southern California Center For Oral & Facial Surgery | |
|
18372 Clark St Suite 224 Tarzana CA 91356-3508 | |
| (818) 996-1200 | |
| (818) 996-1325 |
| Full Name | Southern California Center For Oral & Facial Surgery |
|---|---|
| Speciality | Dentist |
| Location | 18372 Clark St, Tarzana, California |
| Authorized Official Name and Position | Jay B Reznick (OWNER) |
| Authorized Official Contact | 8189961200 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southern California Center For Oral & Facial Surgery 18372 Clark St Suite 224 Tarzana CA 91356-3508 Ph: (818) 996-1200 | Southern California Center For Oral & Facial Surgery 18372 Clark St Suite 224 Tarzana CA 91356-3508 Ph: (818) 996-1200 |
| NPI Number | 1003016494 |
|---|---|
| Provider Enumeration Date | 07/23/2007 |
| Last Update Date | 12/11/2007 |
| Medicare PECOS PAC ID | 8325121510 |
|---|---|
| Medicare Enrollment ID | O20080211000879 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003016494 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0106X | Dentist - Oral And Maxillofacial Pathology | A055148 (California) | Secondary |
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | A055148 (California) | Primary |
| Provider Name | Jay B Reznick |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1962519272 PECOS PAC ID: 7416030606 Enrollment ID: I20080211000878 |
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