Healthcare Provider Details

I. General information

NPI: 1407052343
Provider Name (Legal Business Name): BEBER DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2007
Last Update Date: 04/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19528 VENTURA BLVD SUITE #322
TARZANA CA
91356-2917
US

IV. Provider business mailing address

19528 VENTURA BLVD SUITE # 322
TARZANA CA
91356-2917
US

V. Phone/Fax

Practice location:
  • Phone: 818-881-6780
  • Fax: 818-975-5098
Mailing address:
  • Phone: 818-881-6780
  • Fax: 818-975-5098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number24745
License Number StateCA

VIII. Authorized Official

Name: DR. DAVID J BEBER
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 818-881-6780