Organization
ANATOLY VAISMAN D.D.S., INC
Active
Parent organization
ANATOLY VAISMAN D.D., INC
Organization subpart
Yes
Provider details
NPI number
Legal business name
ANATOLY VAISMAN D.D., INC
Authorized official
MARIA CARLOS (OFFICE MANAGE)
(818) 365-7191
Entity
Organization
Contact information
Practice address
11273 LAUREL CANYON BLVD STE 3, SAN FERNANDO, CA 91340-4358
(818) 365-7191
(818) 361-7641
Mailing address
11273 LAUREL CANYON BLVD STE 3, SAN FERNANDO, CA 91340-4358
(818) 365-7191
(818) 361-7641
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
43259
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
G93630-01
—
CA
Enumeration date
04/01/2009
Last updated
04/01/2009
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