| Vivian C. Banaria, Dmd, Inc. | |
|
5300 Santa Monica Blvd Ste. 401 Los Angeles CA 90029-1131 | |
| (323) 957-9227 | |
| Not Available |
| Full Name | Vivian C. Banaria, Dmd, Inc. |
|---|---|
| Speciality | Dentist |
| Location | 5300 Santa Monica Blvd, Los Angeles, California |
| Authorized Official Name and Position | Vivian Banaria (PRESIDENT) |
| Authorized Official Contact | 3239579227 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Vivian C. Banaria, Dmd, Inc. 5300 Santa Monica Blvd Ste. 401 Los Angeles CA 90029-1131 Ph: (323) 957-9227 | Vivian C. Banaria, Dmd, Inc. 5300 Santa Monica Blvd Ste. 401 Los Angeles CA 90029-1131 Ph: (323) 957-9227 |
| NPI Number | 1417391616 |
|---|---|
| Provider Enumeration Date | 04/18/2013 |
| Last Update Date | 04/18/2013 |
| Medicare PECOS PAC ID | 5890046544 |
|---|---|
| Medicare Enrollment ID | O20180919004157 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417391616 | NPI | - | NPPES |
| 56586 | Other | CA | CA DENTAL BOARD LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 56586 (California) | Primary |
| Provider Name | Vivian C Banaria |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1245589126 PECOS PAC ID: 7618228370 Enrollment ID: I20180919004252 |
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