Healthcare Provider Details

I. General information

NPI: 1811260003
Provider Name (Legal Business Name): ANDREA B HOLSTEIN DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2012
Last Update Date: 02/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10921 WILSHIRE BLVD SUITE 807
LOS ANGELES CA
90024-3906
US

IV. Provider business mailing address

3207 FRYMAN RD
STUDIO CITY CA
91604-4115
US

V. Phone/Fax

Practice location:
  • Phone: 310-209-5050
  • Fax: 310-209-5550
Mailing address:
  • Phone: 818-761-8851
  • Fax: 818-761-8851

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number48611
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: