# BUSTAMANTE ENDODONTICS ADC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1710074513
- **Authorized official:** DR. MANUEL A. BUSTAMANTE D.D.S. (PRESIDENT)
- **Authorized official phone:** (310) 473-5559

## Contact information

- **Practice address:** 11645 WILSHIRE BLVD, SUITE 1160, LOS ANGELES, CA 90025-6811
- **Practice address phone:** (310) 473-5559
- **Mailing address:** 11645 WILSHIRE BLVD, SUITE 1160, LOS ANGELES, CA 90025-6811
- **Mailing address phone:** (310) 473-5559

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223E0200X | Endodontics | 29218 | CA | Yes |

## Other

- **Enumeration date:** 10/05/2006
- **Last updated:** 08/22/2020