Healthcare Provider Details

I. General information

NPI: 1174644454
Provider Name (Legal Business Name): STEVEN J FLESCH D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 02/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16260 VENTURA BLVD SUITE 225
ENCINO CA
91436-2203
US

IV. Provider business mailing address

16260 VENTURA BLVD SUITE 225
ENCINO CA
91436
US

V. Phone/Fax

Practice location:
  • Phone: 818-783-1313
  • Fax:
Mailing address:
  • Phone: 818-783-1313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number23302
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: