Healthcare Provider Details

I. General information

NPI: 1962614057
Provider Name (Legal Business Name): MOREL FIDLER D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6222 WILSHIRE BLVD STE 304
LOS ANGELES CA
90048-5193
US

IV. Provider business mailing address

6222 WILSHIRE BLVD STE 304
LOS ANGELES CA
90048-5193
US

V. Phone/Fax

Practice location:
  • Phone: 323-935-1882
  • Fax: 323-935-1897
Mailing address:
  • Phone: 323-935-1882
  • Fax: 323-935-1897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number18466
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: