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General NPI Number Information
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NPI Number | 1417142050
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Entity Type | Organization
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Legal Business Name | VANOWEN DENTAL CENTER
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Dates
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Enumeration Date | 09/06/2007
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Last Update Date | 09/06/2007
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Provider Practice Location Address
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Address Line | 6931 VAN NUYS BLVD STE 100
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City | VAN NUYS
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State | CA
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Zip | 91405-3937
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Country | US
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Telephone | 818-988-8080
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Fax | 818-988-8168
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Provider Business Mailing Address
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Address Line | 6931 VAN NUYS BLVD STE 100
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City | VAN NUYS
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State | CA
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Zip | 91405-3937
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Country | US
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Telephone | 818-988-8080
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Fax | 818-988-8168
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Authorized Official
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Title or Position | BUSINESS PARTNER
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Name | DR. YENI SUTANTO
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Credential | D.D.S.
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Telephone | 818-988-8080
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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 | B39212
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License Number State | CA
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