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General NPI Number Information
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NPI Number | 1407360522
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Entity Type | Organization
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Legal Business Name | BAUM ORTHODONTICS
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Dates
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Enumeration Date | 11/28/2017
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Last Update Date | 11/28/2017
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Provider Practice Location Address
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Address Line | 8540 S SEPULVEDA BLVD STE 1012
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City | LOS ANGELES
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State | CA
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Zip | 90045-3819
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Country | US
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Telephone | 310-670-1411
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Fax |
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Provider Business Mailing Address
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Address Line | 8540 S SEPULVEDA BLVD STE 1012
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City | LOS ANGELES
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State | CA
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Zip | 90045-3819
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | SUSANA SARAVIA-NELSON
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Credential |
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Telephone | 310-670-1411
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 44400
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 27953
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 29557
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License Number State | CA
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