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General NPI Number Information
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NPI Number | 1114327004
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Entity Type | Organization
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Legal Business Name | GALINA STOLYAR DDS PROFESSIONAL DENTAL CORPORATION
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Dates
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Enumeration Date | 08/27/2014
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Last Update Date | 08/23/2021
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Provider Practice Location Address
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Address Line | 11755 VICTORY BLVD STE 101
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City | NORTH HOLLYWOOD
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State | CA
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Zip | 91606-3447
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Country | US
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Telephone | 818-761-0010
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Fax | 818-761-0012
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Provider Business Mailing Address
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Address Line | 11755 VICTORY BLVD STE 101
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City | NORTH HOLLYWOOD
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State | CA
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Zip | 91606-3447
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Country | US
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Telephone | 818-761-0010
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Fax | 818-761-0012
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Authorized Official
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Title or Position | CEO
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Name | GALINA STOLYAR
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Credential |
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Telephone | 818-641-9037
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 48027
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License Number State | CA
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