Healthcare Provider Details

I. General information

NPI: 1861630725
Provider Name (Legal Business Name): STANLEY A. ORGAN, DDS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2009
Last Update Date: 10/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

699 HAMPSHIRE RD STE 209
WESTLAKE VILLAGE CA
91361-2351
US

IV. Provider business mailing address

699 HAMPSHIRE RD STE 209
WESTLAKE VILLAGE CA
91361-2351
US

V. Phone/Fax

Practice location:
  • Phone: 805-494-4887
  • Fax: 805-494-4547
Mailing address:
  • Phone: 805-494-4887
  • Fax: 805-494-4547

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number20566
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number52055
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number52046
License Number StateCA

VIII. Authorized Official

Name: DR. STANLEY ALLAN ORGAN
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 805-494-4887