Organization
UCLA PERIODONTAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. FLAVIA PIRIH DDS, PHD (CHAIR)
(310) 825-6486
Entity
Organization
Contact information
Practice address
UCLA SCHOOL OF DENTISTRY, CHS B0 130, LOS ANGELES, CA 90095-1668
(310) 825-3795
(310) 825-9653
Mailing address
10833 LE CONTE AVE, CHS BO 130, LOS ANGELES, CA 90095-1668
(310) 825-3795
(310) 825-9653
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
2059
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02059
DELTA DENTAL OF CA GROUP
CA
01
—
D34623
DENTICAL
CA
Enumeration date
09/20/2006
Last updated
05/10/2021
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