Organization
ORTHODONTICS ONLY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROSA SALAZAR (ADMINISTRATOR)
(310) 644-4412
Entity
Organization
Contact information
Practice address
11633 HAWTHORNE BLVD, STE. 500, HAWTHORNE, CA 90250-2321
(310) 644-4412
(310) 644-7355
Mailing address
11633 HAWTHORNE BLVD, STE. 500, HAWTHORNE, CA 90250-2321
(310) 644-4412
(310) 644-7355
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
17997
CA
Other
Enumeration date
04/27/2016
Last updated
04/27/2016
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