Organization
KONVISER DENTAL PROFESSIONAL CORPORATION
Active
Other names
OceanBreeze Dental
Organization subpart
No
Provider details
NPI number
Authorized official
VADIM KONVISER DDS (CEO)
(310) 578-2500
Entity
Organization
Contact information
Practice address
4644 LINCOLN BLVD STE 404, MARINA DEL REY, CA 90292-6380
(310) 578-2500
Mailing address
4644 LINCOLN BLVD STE 404, MARINA DEL REY, CA 90292-6380
(310) 578-2500
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
51095
CA
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
51095
CA
Other
Enumeration date
08/29/2018
Last updated
08/29/2018
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