| NPI | 1245570043 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ILYA ZAK Owner Dentist 310-706-5273 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 38238) |
| Additional Taxonomies | 1223E0200X Dentist Endodontics (Licence: CA 20673) |
| 1223G0001X Dentist General Practice (Licence: CA 61574) | |
| 1223P0221X Dentist Pediatric Dentistry (Licence: CA 50315) | |
| 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: CA 48198) | |
| 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: CA 57513) | |
| Enumeration Date | 2013-02-15 |
| Last Update Date | 2016-04-14 |