Healthcare Provider Details

I. General information

NPI: 1952566820
Provider Name (Legal Business Name): FAINA GELMAN D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2008
Last Update Date: 07/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11273 LAUREL CANYON BLVD #3
SAN FERNANDO CA
91340-4300
US

IV. Provider business mailing address

11273 LAUREL CANYON BLVD #3
SAN FERNANDO CA
91340-4300
US

V. Phone/Fax

Practice location:
  • Phone: 310-995-4465
  • Fax:
Mailing address:
  • Phone: 310-995-4465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number54988
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: