Healthcare Provider Details

I. General information

NPI: 1184801789
Provider Name (Legal Business Name): DR. JEANNIE ANN MOLATO D.M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2008
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7133 SEPULVEDA BLVD.
VAN NUYS CA
91405
US

IV. Provider business mailing address

7133 SEPULVEDA BLVD.
VAN NUYS CA
91405
US

V. Phone/Fax

Practice location:
  • Phone: 818-988-8184
  • Fax: 818-988-8727
Mailing address:
  • Phone: 818-988-8184
  • Fax: 818-988-8727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number48054
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number44948
License Number StateCA

VIII. Authorized Official

Name: DR. JEANNIE ANN MOLATO
Title or Position: OWNER/DENTIST
Credential: DMD
Phone: 818-988-8184