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General NPI Number Information
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NPI Number | 1063950244
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Entity Type | Organization
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Legal Business Name | VAFA DENTAL CORP
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Dates
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Enumeration Date | 02/07/2017
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Last Update Date | 02/07/2017
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Provider Practice Location Address
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Address Line | 7865 SANTA MONICA BLVD
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City | WEST HOLLYWOOD
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State | CA
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Zip | 90046-5344
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Country | US
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Telephone | 323-654-2840
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Fax |
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Provider Business Mailing Address
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Address Line | 7865 SANTA MONICA BLVD
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City | WEST HOLLYWOOD
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State | CA
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Zip | 90046-5344
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Country | US
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Telephone | 323-654-2840
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Fax |
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Authorized Official
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Title or Position | TX COORDINATOR
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Name | SANDY SCOTT
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Credential |
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Telephone | 310-201-9001
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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 | 52126
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License Number State | CA
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