Healthcare Provider Details

I. General information

NPI: 1851136782
Provider Name (Legal Business Name): FUN VALLEY KIDS DENTAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2024
Last Update Date: 07/01/2024
Certification Date: 07/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8805 SUNLAND BLVD
SUN VALLEY CA
91352-2833
US

IV. Provider business mailing address

8805 SUNLAND BLVD
SUN VALLEY CA
91352-2833
US

V. Phone/Fax

Practice location:
  • Phone: 818-767-5243
  • Fax:
Mailing address:
  • Phone: 818-767-5243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LUCY GEOZALIAN
Title or Position: OFFICE MANAGER
Credential:
Phone: 818-482-9798