Healthcare Provider Details

I. General information

NPI: 1881098630
Provider Name (Legal Business Name): BURTON D SCHNIEROW DDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2014
Last Update Date: 10/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13450 HAWTHORNE BLVD
HAWTHORNE CA
90250-5806
US

IV. Provider business mailing address

13450 HAWTHORNE BLVD
HAWTHORNE CA
90250-5806
US

V. Phone/Fax

Practice location:
  • Phone: 310-679-0106
  • Fax: 310-679-6698
Mailing address:
  • Phone: 310-679-0106
  • Fax: 310-679-6698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number56609
License Number StateCA

VIII. Authorized Official

Name: MISS GEANNIE TOMAS
Title or Position: CREDENTIALING
Credential:
Phone: 310-679-0106