Organization
WILSHIRE ORAL SURGERY & IMPLANT CENTER
Active
Other names
Jonathan Shadi, DDS, Inc
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JONATHAN SHADI DDS (PRESIDENT)
(310) 652-6553
Entity
Organization
Contact information
Practice address
12300 WILSHIRE BLVD, SUITE #326, LOS ANGELES, CA 90025-1020
(310) 652-6553
(310) 652-6553
Mailing address
12300 WILSHIRE BLVD, SUITE #326, LOS ANGELES, CA 90025-1020
(310) 652-6553
(310) 652-6553
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
58812
CA
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
63560
CA
Other
Enumeration date
12/08/2016
Last updated
12/13/2016
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