Individual
DR. IRVIN RICHARD MASSOTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS, MSD
Contact information
Practice address
5567 RESEDA BLVD, #100, TARZANA, CA 91356-2674
(818) 705-1274
(818) 705-6782
Mailing address
5567 RESEDA BLVD, #100, TARZANA, CA 91356-2674
(818) 705-1274
(818) 705-6782
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
28957
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
709866
UNITED CONCORDIA-TAX ID
CA
Enumeration date
11/01/2006
Last updated
07/08/2007
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