| West Los Angeles Dentistry | |
|
11870 Santa Monica Blvd Suite 212 Los Angeles CA 90025-2281 | |
| (310) 207-4900 | |
| (310) 207-8358 |
| Full Name | West Los Angeles Dentistry |
|---|---|
| Speciality | Clinic/Center |
| Location | 11870 Santa Monica Blvd, Los Angeles, California |
| Authorized Official Name and Position | Robert Hazany (DENTIST PARTNER) |
| Authorized Official Contact | 3102074900 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| West Los Angeles Dentistry 11870 Santa Monica Blvd Suite 212 Los Angeles CA 90025-2281 Ph: (310) 207-4900 | West Los Angeles Dentistry 11870 Santa Monica Blvd Suite 212 Los Angeles CA 90025-2281 Ph: (310) 207-4900 |
| NPI Number | 1508923707 |
|---|---|
| Provider Enumeration Date | 01/03/2007 |
| Last Update Date | 03/15/2011 |
| Medicare PECOS PAC ID | 6901231497 |
|---|---|
| Medicare Enrollment ID | O20200109002239 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508923707 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
| Provider Name | Robert Hazany |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1669740429 PECOS PAC ID: 7719312206 Enrollment ID: I20200109002416 |
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