Organization Name: | ANATOLY VAISMAN D.D.S., INC |
NPI Number: | 1023166600 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | ANATOLY VAISMAN (OWNER/DENTIST) |
Mailing Address: | 11273 Laurel Canyon Blvd Suite#3 San Fernando |
State: | CA US |
Postal Code: | 913404300 |
Phone Number: | 8183657191 |
Fax Number: | 8183617641 |
NPI Enumeration Date: | 01/08/2007 |
NPI Last Update Date: | 08/18/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QD0000X |
License Number: | 88476-48 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Dental |
Taxonomy Definition: |