Organization Name: | CHATSWORTH FAMILY DENTAL GROUP |
NPI Number: | 1003109612 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | ALAN RICHARD WOLFSON (OWNER) |
Mailing Address: | 21029 Devonshire St Chatsworth |
State: | CA US |
Postal Code: | 913112315 |
Phone Number: | 8189986446 |
Fax Number: | |
NPI Enumeration Date: | 05/16/2011 |
NPI Last Update Date: | 05/16/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QD0000X |
License Number: | D28675 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | CA |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Dental |
Taxonomy Definition: |