Healthcare Provider Details

I. General information

NPI: 1447623525
Provider Name (Legal Business Name): SERGEY LOKOT DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2015
Last Update Date: 11/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5363 BALBOA BLVD STE 233
ENCINO CA
91316-2824
US

IV. Provider business mailing address

5363 BALBOA BLVD STE 233
ENCINO CA
91316-2824
US

V. Phone/Fax

Practice location:
  • Phone: 818-788-4424
  • Fax: 818-788-4426
Mailing address:
  • Phone: 818-788-4424
  • Fax: 818-788-4426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number58921
License Number StateCA

VIII. Authorized Official

Name: MS. NATALIE KOLKOVICH
Title or Position: OFFICE MANAGER
Credential:
Phone: 818-788-4424