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General NPI Number Information
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NPI Number | 1194879627
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Entity Type | Organization
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Legal Business Name | 6TH STREET FAMILY DENTAL GROUP
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Dates
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Enumeration Date | 01/22/2007
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Last Update Date | 06/13/2008
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Provider Practice Location Address
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Address Line | 2065 W 6TH STREET SUITE 109
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City | LOS ANGELES
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State | CA
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Zip | 90057
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Country | US
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Telephone | 213-484-2100
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Fax | 213-484-1474
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Provider Business Mailing Address
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Address Line | 2065 W 6TH STREET SUITE 109
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City | LOS ANGELES
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State | CA
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Zip | 90057
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Country | US
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Telephone | 213-484-2100
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Fax | 213-484-1474
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Authorized Official
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Title or Position | PARTNER
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Name | SUSAN HAZANY
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Credential | DDS
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Telephone | 213-484-2100
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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 | 41084
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 39963
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License Number State | CA
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