Healthcare Provider Details

I. General information

NPI: 1457548810
Provider Name (Legal Business Name): FANY TRUTANIC DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2007
Last Update Date: 12/21/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

818 W ALONDRA BLVD
COMPTON CA
90220-3500
US

IV. Provider business mailing address

818 W ALONDRA BLVD
COMPTON CA
90220-3500
US

V. Phone/Fax

Practice location:
  • Phone: 310-738-0374
  • Fax:
Mailing address:
  • Phone: 310-738-0374
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number25334
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: