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General NPI Number Information
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NPI Number | 1225645633
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Entity Type | Organization
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Legal Business Name | LANCASTER ADVANCED DENTAL INC.
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Dates
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Enumeration Date | 09/29/2020
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Last Update Date | 10/01/2020
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Provider Practice Location Address
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Address Line | 1745 W AVENUE K STE C
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City | LANCASTER
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State | CA
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Zip | 93534-6504
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Country | US
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Telephone | 661-723-5400
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Fax | 661-723-3944
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Provider Business Mailing Address
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Address Line | 18301 RANCHO ST
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City | TARZANA
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State | CA
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Zip | 91356-4600
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Country | US
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Telephone | 818-355-3898
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. SHARONA KOHANOFF
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Credential | DDS
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Telephone | 661-723-5400
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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 |
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License Number State |
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