Healthcare Provider Details

I. General information

NPI: 1801711601
Provider Name (Legal Business Name): GRANADA CITY DENTAL A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16917 DEVONSHIRE ST
GRANADA HILLS CA
91344-7407
US

IV. Provider business mailing address

16917 DEVONSHIRE ST
GRANADA HILLS CA
91344-7407
US

V. Phone/Fax

Practice location:
  • Phone: 818-488-9468
  • Fax:
Mailing address:
  • Phone: 818-488-9468
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MELISA HERNANDEZ
Title or Position: PRESIDENT
Credential:
Phone: 818-488-9468