# 101 DENTAL GROUP

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

## Provider details

- **NPI number:** 1760813802
- **Authorized official:** AMIR H CHOROOMI (DENTIST)
- **Authorized official phone:** (818) 735-3800

## Contact information

- **Practice address:** 7259 OWENSMOUTH AVE, CANOGA PARK, CA 91303-1530
- **Practice address phone:** (818) 999-9900
- **Practice address fax:** (818) 999-9978
- **Mailing address:** 7259 OWENSMOUTH AVE, CANOGA PARK, CA 91303-1530
- **Mailing address phone:** (818) 999-9900
- **Mailing address fax:** (818) 999-9978

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 54634 | CA | Yes |

## Other

- **Enumeration date:** 11/27/2013
- **Last updated:** 11/27/2013