Healthcare Provider Details

I. General information

NPI: 1619545159
Provider Name (Legal Business Name): TASKER AND ROWAN DENTAL CORPORATION OF BEVERLY HILLS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2021
Last Update Date: 06/11/2021
Certification Date: 06/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8635 W 3RD ST STE 255
LOS ANGELES CA
90048-6113
US

IV. Provider business mailing address

8635 W 3RD ST STE 255
LOS ANGELES CA
90048-6113
US

V. Phone/Fax

Practice location:
  • Phone: 916-479-3432
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: JEANNINE SASO
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 916-479-3432