# GLENDALE SURGICAL ASSOCIATES, LP

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** GLENDALE SURGICAL ASSOCIATES, LP
- **Other names:** Pacific Coast OMS
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1497003685
- **Legal business name:** GLENDALE SURGICAL ASSOCIATES, LP
- **Authorized official:** DIANNE LAFAURIE (OFFICE MANAGER)
- **Authorized official phone:** (818) 241-4217

## Contact information

- **Practice address:** 11550 INDIAN HILLS RD STE 270, MISSION HILLS, CA 91345-1244
- **Practice address phone:** (818) 365-5636
- **Practice address fax:** (818) 365-5639
- **Mailing address:** 11550 INDIAN HILLS RD STE 270, MISSION HILLS, CA 91345-1244
- **Mailing address phone:** (818) 365-5636
- **Mailing address fax:** (818) 365-5639

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 21413 | CA | — |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 37945 | CA | — |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | OMS71 | CA | — |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | OMS94 | CA | Yes |

## Other

- **Enumeration date:** 08/21/2012
- **Last updated:** 08/21/2012