# KONVISER DENTAL PROFESSIONAL CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Other names:** OceanBreeze Dental
- **Organization subpart:** No

## Provider details

- **NPI number:** 1831670637
- **Authorized official:** VADIM KONVISER DDS (CEO)
- **Authorized official phone:** (310) 578-2500

## Contact information

- **Practice address:** 4644 LINCOLN BLVD STE 404, MARINA DEL REY, CA 90292-6380
- **Practice address phone:** (310) 578-2500
- **Mailing address:** 4644 LINCOLN BLVD STE 404, MARINA DEL REY, CA 90292-6380
- **Mailing address phone:** (310) 578-2500

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 51095 | CA | Yes |

## Other

- **Enumeration date:** 08/28/2018
- **Last updated:** 08/28/2018