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14547 Titus St Ste 207 Panorama City CA 91402-4932 | |
| (818) 785-4282 | |
| (818) 785-8704 |
| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 14547 Titus St Ste 207, Panorama City, California |
| Authorized Official Name and Position | Jonathan L Maddatu (DENTIST/ OWNER) |
| Authorized Official Contact | 8187854282 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
14547 Titus St Ste 207 Panorama City CA 91402-4932 Ph: (818) 785-4282 | 14547 Titus St Ste 207 Panorama City CA 91402-4932 Ph: (818) 785-4282 |
| NPI Number | 1962893115 |
|---|---|
| Provider Enumeration Date | 02/10/2015 |
| Last Update Date | 05/30/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962893115 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 55562 (California) | Primary |
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