Healthcare Provider Details

I. General information

NPI: 1780640144
Provider Name (Legal Business Name): GEORGE A MARANON D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 03/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16311 VENTURA BLVD SUITE 820
ENCINO CA
91436-2124
US

IV. Provider business mailing address

16311 VENTURA BLVD SUITE 820
ENCINO CA
91436-2124
US

V. Phone/Fax

Practice location:
  • Phone: 818-990-5500
  • Fax: 818-990-5520
Mailing address:
  • Phone: 818-990-5500
  • Fax: 818-990-5520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberD32127
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: