Organization
MARINA COSMETIC IMPLANT DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL HOMAYUN D.D.S. (OWNER)
(310) 821-2677
Entity
Organization
Contact information
Practice address
4640 ADMIRALTY WAY, 1001, MARINA DEL REY, CA 90292-6621
(310) 821-2677
Mailing address
4640 ADMIRALTY WAY, 1001, MARINA DEL REY, CA 90292-6621
(310) 821-2677
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
37838
CA
Other
Enumeration date
05/17/2007
Last updated
08/22/2020
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