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General NPI Number Information
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NPI Number | 1134304728
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Entity Type | Organization
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Legal Business Name | DR.JACOB SLUTSKY, DDS INC.
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Dates
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Enumeration Date | 01/02/2008
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Last Update Date | 01/02/2008
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Provider Practice Location Address
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Address Line | 1964 WESTWOOD BLVD STE 145
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City | LOS ANGELES
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State | CA
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Zip | 90025-4683
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Country | US
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Telephone | 310-474-5575
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Fax | 310-475-1172
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Provider Business Mailing Address
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Address Line | 1964 WESTWOOD BLVD STE 145
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City | LOS ANGELES
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State | CA
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Zip | 90025-4683
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Country | US
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Telephone | 310-474-5575
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Fax | 310-475-1172
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Authorized Official
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Title or Position | OWNER
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Name | DR. JACOB J SLUTSKY
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Credential | D.D.S.
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Telephone | 310-474-5575
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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 | 40311
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License Number State | CA
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