Healthcare Provider Details

I. General information

NPI: 1083453096
Provider Name (Legal Business Name): HENDERSON KANE AND ANFRUNS DENTAL PARTNERSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2024
Last Update Date: 05/20/2024
Certification Date: 05/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

881 ALMA REAL DR APT 205A
PACIFIC PALISADES CA
90272-5048
US

IV. Provider business mailing address

881 ALMA REAL DR APT 205A
PACIFIC PALISADES CA
90272-5048
US

V. Phone/Fax

Practice location:
  • Phone: 310-454-0912
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JOAN PI ANFRUNS
Title or Position: PARTNER
Credential: DMD
Phone: 310-454-0912