Healthcare Provider Details

I. General information

NPI: 1982937843
Provider Name (Legal Business Name): ZACHARY A. CARNOW, DDS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2009
Last Update Date: 09/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5453 E BEVERLY BLVD
LOS ANGELES CA
90022-2207
US

IV. Provider business mailing address

5453 E BEVERLY BLVD
LOS ANGELES CA
90022-2207
US

V. Phone/Fax

Practice location:
  • Phone: 323-723-8249
  • Fax: 323-721-9132
Mailing address:
  • Phone: 323-723-8249
  • Fax: 323-721-9132

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number58697
License Number StateCA

VIII. Authorized Official

Name: DR. ZACHARY ALLEN CARNOW
Title or Position: GENERAL DENTIST
Credential: DDS
Phone: 323-723-8249