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General NPI Number Information
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NPI Number | 1225428824
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Entity Type | Organization
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Legal Business Name | BLUE PEARL DENTISTRY
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Dates
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Enumeration Date | 02/03/2015
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Last Update Date | 02/03/2015
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Provider Practice Location Address
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Address Line | 1080 S LA CIENEGA BLVD SUITE 206
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City | LOS ANGELES
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State | CA
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Zip | 90035-2591
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Country | US
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Telephone | 424-288-4175
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Fax |
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Provider Business Mailing Address
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Address Line | 1080 S LA CIENEGA BLVD SUITE 206
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City | LOS ANGELES
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State | CA
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Zip | 90035-2591
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Country | US
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Telephone | 424-288-4175
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Fax |
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Authorized Official
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Title or Position | DDS
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Name | ROBERT S HUANG
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Credential |
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Telephone | 424-288-4175
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 56353
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License Number State | CA
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