# DEREK L VAJDA DDS MD INC

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

## Provider details

- **NPI number:** 1760050736
- **Authorized official:** DR. DEREK LUDOVIT VAJDA DDS, MD (PRESIDENT)
- **Authorized official phone:** (219) 789-8308

## Contact information

- **Practice address:** 501 S GARFIELD AVE, ALHAMBRA, CA 91801-3840
- **Practice address phone:** (626) 570-1818
- **Mailing address:** 1541 CENTINELA AVE, UNIT 105, SANTA MONICA, CA 90404-3222
- **Mailing address phone:** (219) 789-8308

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | Yes |

## Other

- **Enumeration date:** 06/15/2021
- **Last updated:** 06/15/2021