Healthcare Provider Details

I. General information

NPI: 1225311574
Provider Name (Legal Business Name): DAVID M FIRESTONE D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2011
Last Update Date: 09/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12435 RIVERSIDE DR
STUDIO CITY CA
91607-3509
US

IV. Provider business mailing address

12435 RIVERSIDE DR
STUDIO CITY CA
91607-3509
US

V. Phone/Fax

Practice location:
  • Phone: 818-980-5700
  • Fax: 818-980-2172
Mailing address:
  • Phone: 818-980-5700
  • Fax: 818-980-2172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD22494
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: