Healthcare Provider Details

I. General information

NPI: 1013101690
Provider Name (Legal Business Name): WESTCHESTER PEDIATRIC DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2007
Last Update Date: 08/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8540 S SEPULVEDA BLVD STE 710
LOS ANGELES CA
90045-3818
US

IV. Provider business mailing address

8540 S SEPULVEDA BLVD STE 710
LOS ANGELES CA
90045-3818
US

V. Phone/Fax

Practice location:
  • Phone: 310-216-5754
  • Fax:
Mailing address:
  • Phone: 310-216-5754
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number47352
License Number StateCA

VIII. Authorized Official

Name: DR. CHRISTIE RACHELLE BURNETT
Title or Position: PARTNER
Credential: DDS
Phone: 310-216-5754