Organization
BUSTAMANTE ENDODONTICS ADC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MANUEL A. BUSTAMANTE D.D.S. (PRESIDENT)
(310) 473-5559
Entity
Organization
Contact information
Practice address
11645 WILSHIRE BLVD, SUITE 1160, LOS ANGELES, CA 90025-6811
(310) 473-5559
Mailing address
11645 WILSHIRE BLVD, SUITE 1160, LOS ANGELES, CA 90025-6811
(310) 473-5559
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
29218
CA
Other
Enumeration date
10/05/2006
Last updated
08/22/2020
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