Organization
FUNDAMINSKY ORAL FACIAL DDS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GENNADY M FUNDAMINSKY MD, DDS (PRESIDENT)
(310) 801-1296
Entity
Organization
Contact information
Practice address
9615 BRIGHTON WAY STE 216, BEVERLY HILLS, CA 90210-5118
(310) 278-0814
Mailing address
9615 BRIGHTON WAY STE 216, BEVERLY HILLS, CA 90210-5118
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
01/30/2023
Last updated
01/30/2023
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