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General NPI Number Information
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NPI Number | 1114214269
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Entity Type | Organization
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Legal Business Name | WARREN J. GEROSA, DDS,INC.
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Dates
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Enumeration Date | 07/08/2011
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Last Update Date | 07/08/2011
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Provider Practice Location Address
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Address Line | 8540 S SEPULVEDA BLVD STE 1212
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City | LOS ANGELES
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State | CA
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Zip | 90045-3819
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Country | US
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Telephone | 310-645-2886
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Fax |
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Provider Business Mailing Address
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Address Line | 8540 S SEPULVEDA BLVD STE 1212
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City | LOS ANGELES
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State | CA
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Zip | 90045-3819
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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 | CEO
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Name | WARREN J GEROSA
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Credential | DDS
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Telephone | 310-645-2886
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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 | 33712
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License Number State | CA
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