Healthcare Provider Details

I. General information

NPI: 1245552769
Provider Name (Legal Business Name): GERARD S FRANKEL D.D.S INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2010
Last Update Date: 02/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10801 VENICE BLVD
LOS ANGELES CA
90034-7103
US

IV. Provider business mailing address

10801 VENICE BLVD
LOS ANGELES CA
90034-7103
US

V. Phone/Fax

Practice location:
  • Phone: 310-836-3476
  • Fax: 310-383-9863
Mailing address:
  • Phone: 310-836-3476
  • Fax: 310-383-9863

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number14086
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number47215
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number53910
License Number StateCA

VIII. Authorized Official

Name: GERARD FRANKEL
Title or Position: OWNER
Credential:
Phone: 310-836-3476