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General NPI Number Information
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NPI Number | 1316077977
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Entity Type | Organization
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Legal Business Name | PEREZ AND STREETER DENTAL CORPORATION
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Dates
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Enumeration Date | 03/06/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3701 STOCKER ST SUITE # 405
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City | LOS ANGELES
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State | CA
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Zip | 90008-5108
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Country | US
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Telephone | 323-291-1024
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Fax | 323-291-2044
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Provider Business Mailing Address
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Address Line | 3701 STOCKER ST SUITE # 405
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City | LOS ANGELES
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State | CA
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Zip | 90008-5108
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Country | US
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Telephone | 323-291-1024
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Fax | 323-291-2044
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Authorized Official
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Title or Position | OWNER
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Name | DR. ELWOOD J. STREETER
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Credential | D.D.S.
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Telephone | 323-291-1024
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 14883
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License Number State | CA
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