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General NPI Number Information
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NPI Number | 1124398250
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Entity Type | Organization
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Legal Business Name | THE CENTER FOR IMPLANT & COSMETIC DENTISTRY
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Dates
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Enumeration Date | 01/05/2012
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Last Update Date | 01/05/2012
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Provider Practice Location Address
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Address Line | 115 JENSEN CT SUITE 100
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City | THOUSAND OAKS
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State | CA
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Zip | 91360-7406
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Country | US
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Telephone | 805-497-2222
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Fax | 805-497-2280
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Provider Business Mailing Address
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Address Line | 115 JENSEN CT SUITE 100
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City | THOUSAND OAKS
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State | CA
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Zip | 91360-7406
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Country | US
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Telephone | 805-497-2222
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Fax | 805-497-2280
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Authorized Official
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Title or Position | DOCTOR / DIRECTOR
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Name | SAM SHERIF
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Credential | DMD, DMEDSC
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Telephone | 805-497-2222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 57628
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License Number State | CA
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