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General NPI Number Information
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NPI Number | 1033319983
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Entity Type | Organization
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Legal Business Name | MICHAEL NY MA DENTAL CORPORATION
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Dates
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Enumeration Date | 07/19/2007
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Last Update Date | 07/19/2007
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Provider Practice Location Address
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Address Line | 711 W COLLEGE ST SUITE 570
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City | LOS ANGELES
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State | CA
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Zip | 90012-1163
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Country | US
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Telephone | 213-617-9151
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Fax | 213-617-1428
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Provider Business Mailing Address
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Address Line | 711 W COLLEGE ST SUITE 570
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City | LOS ANGELES
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State | CA
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Zip | 90012-1163
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHAEL NY MA
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Credential | D.D.S.
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Telephone | 213-617-9151
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 28954
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License Number State | CA
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