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General NPI Number Information
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NPI Number | 1043844301
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Entity Type | Organization
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Legal Business Name | ATALLA DENTAL CORP.
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Dates
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Enumeration Date | 02/26/2020
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Last Update Date | 02/26/2020
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Provider Practice Location Address
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Address Line | 557 N. MACLAY AVE.
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City | SAN FERNANDO
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State | CA
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Zip | 91340
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Country | US
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Telephone | 559-804-3130
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Fax |
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Provider Business Mailing Address
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Address Line | 9839 BELMAR AVE
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City | NORTHRIDGE
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State | CA
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Zip | 91324-1655
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Country | US
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Telephone | 559-804-3130
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | HANNA ATALLA
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Credential | DDS
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Telephone | 559-804-3130
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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 |
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License Number State |
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