Healthcare Provider Details

I. General information

NPI: 1457834889
Provider Name (Legal Business Name): WILLIAM GINZBURG DENTAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2018
Last Update Date: 09/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13286 FIJI WAY
MARINA DEL REY CA
90292-7119
US

IV. Provider business mailing address

13286 FIJI WAY
MARINA DEL REY CA
90292-7119
US

V. Phone/Fax

Practice location:
  • Phone: 310-821-2611
  • Fax:
Mailing address:
  • Phone: 310-821-2611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM GINZBURG
Title or Position: PRESIDENT
Credential: DDS
Phone: 310-268-0646