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Organization

DR. SHAGRAMANOVA DENTAL GROUP, INC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
NATALYA SHAGRAMANOVA DDS (CEO/DENTIST)
(818) 653-7778
Entity
Organization

Contact information

Practice address
3175 FIRESTONE BLVD, SOUTH GATE, CA 90280-2951
(323) 484-1020
Mailing address
3175 FIRESTONE BLVD, SOUTH GATE, CA 90280-2951
(323) 484-1020

Taxonomy

Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1023051646
RENDERING PROVIDER NUMBER
CA
Enumeration date
01/09/2019
Last updated
01/09/2019
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