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General NPI Number Information
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NPI Number | 1003109612
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Entity Type | Organization
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Legal Business Name | CHATSWORTH FAMILY DENTAL GROUP
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Dates
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Enumeration Date | 05/16/2011
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Last Update Date | 05/16/2011
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Provider Practice Location Address
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Address Line | 21029 DEVONSHIRE ST
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City | CHATSWORTH
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State | CA
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Zip | 91311-2315
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Country | US
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Telephone | 818-998-6446
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Fax |
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Provider Business Mailing Address
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Address Line | 21029 DEVONSHIRE ST
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City | CHATSWORTH
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State | CA
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Zip | 91311-2315
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Country | US
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Telephone | 818-998-6446
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ALAN RICHARD WOLFSON
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Credential | D,D.S.
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Telephone | 818-998-6446
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | D28675
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | D27858
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License Number State | CA
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