Individual
DAVITA DANESH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6846 RESEDA BLVD, RESEDA, CA 91335-8509
(818) 578-5170
Mailing address
2802 WOODWARDIA DR, LOS ANGELES, CA 90077-2123
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DDS104130
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
DDS104130
—
CA
Enumeration date
08/28/2019
Last updated
08/28/2019
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