Organization
RESEDA VILLAGE DENTAL STUDIO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARMAINE MARIE ALEXANDER (OFFICE MANAGER)
(818) 757-7070
Entity
Organization
Contact information
Practice address
18700 SHERMAN WAY STE 116, RESEDA, CA 91335-9101
(818) 757-7070
(818) 757-7788
Mailing address
18700 SHERMAN WAY STE 116, RESEDA, CA 91335-9101
(818) 757-7070
(818) 757-7788
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
54191
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
525031
MEDI-CAL
CA
Enumeration date
02/25/2010
Last updated
02/25/2010
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