Organization
GLENDALE SURGICAL ASSOCIATES, LP
Active
Parent organization
GLENDALE SURGICAL ASSOCIATES, LP
Other names
Pacific Coast OMS
Organization subpart
Yes
Provider details
NPI number
Legal business name
GLENDALE SURGICAL ASSOCIATES, LP
Authorized official
DIANNE LAFAURIE (OFFICE MANAGER)
(818) 241-4217
Entity
Organization
Contact information
Practice address
11550 INDIAN HILLS RD STE 270, MISSION HILLS, CA 91345-1244
(818) 365-5636
(818) 365-5639
Mailing address
11550 INDIAN HILLS RD STE 270, MISSION HILLS, CA 91345-1244
(818) 365-5636
(818) 365-5639
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
21413
CA
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
37945
CA
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
OMS71
CA
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
OMS94
CA
Other
Enumeration date
08/21/2012
Last updated
08/21/2012
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