| Ucla Periodontal Clinic | |
|
Ucla School Of Dentistry Chs B0 130 Los Angeles CA 90095-1668 | |
| (310) 825-3795 | |
| (310) 825-9653 |
| Full Name | Ucla Periodontal Clinic |
|---|---|
| Speciality | Dentist - Periodontics |
| Location | Ucla School Of Dentistry, Los Angeles, California |
| Authorized Official Name and Position | Flavia Pirih (CHAIR) |
| Authorized Official Contact | 3108256486 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ucla Periodontal Clinic 10833 Le Conte Ave Chs Bo 130 Los Angeles CA 90095-1668 Ph: (310) 825-3795 | Ucla Periodontal Clinic Ucla School Of Dentistry Chs B0 130 Los Angeles CA 90095-1668 Ph: (310) 825-3795 |
| NPI Number | 1376641720 |
|---|---|
| Provider Enumeration Date | 09/20/2006 |
| Last Update Date | 05/10/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376641720 | NPI | - | NPPES |
| D34623 | Other | CA | DENTICAL |
| 02059 | Other | CA | DELTA DENTAL OF CA GROUP |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0300X | Dentist - Periodontics | 2059 (California) | Primary |
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