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General NPI Number Information
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NPI Number | 1053552562
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Entity Type | Organization
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Legal Business Name | CALABASAS CENTER FOR ORAL SURGERY
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Dates
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Enumeration Date | 03/12/2009
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Last Update Date | 12/30/2014
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Provider Practice Location Address
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Address Line | 24013 VENTURA BLVD SUITE 100
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City | CALABASAS
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State | CA
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Zip | 91302-1447
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Country | US
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Telephone | 818-225-2211
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Fax | 818-225-7478
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Provider Business Mailing Address
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Address Line | 24013 VENTURA BLVD SUITE 100
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City | CALABASAS
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State | CA
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Zip | 91302-1447
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Country | US
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Telephone | 818-225-2211
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Fax | 818-225-7478
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ALEXEI I MIZIN
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Credential | DMD
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Telephone | 818-225-2211
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 54286
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License Number State | CA
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