MEDICARE: DR. MICHAEL EILENBERG

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	27750	CA

General Provider Information

NPI Number	:	1265766174
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL EILENBERG

Provider Business Mailing Address
First Line	:	11980 SAN VICENTE BLVD STE 901
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90049-6607
Country	:	US
Telephone Number	:	310-820-0093
Fax Number	:	310-820-0494

Provider Business Practice Location Address
First Line	:	11980 SAN VICENTE BLVD STE 901
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90049-6607
Country	:	US
Telephone Number	:	310-820-0093
Fax Number	:	310-820-0494

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/24/2009
Last Update Date	:	09/24/2009

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