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General NPI Number Information
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NPI Number | 1417776089
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Entity Type | Organization
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Legal Business Name | TOP DENTAL HUNTINGTON PARK INC
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Dates
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Enumeration Date | 10/09/2024
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Last Update Date | 10/09/2024
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Provider Practice Location Address
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Address Line | 6416 SANTA FE AVE
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City | HUNTINGTON PARK
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State | CA
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Zip | 90255
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Country | US
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Telephone | 844-741-8600
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Fax |
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Provider Business Mailing Address
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Address Line | 2707 WEST OLYMPIC BLVD 202
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City | LOS ANGELES
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State | CA
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Zip | 90006
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Country | US
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Telephone | 415-602-2208
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ANDREW LEE
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Credential |
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Telephone | 415-602-2208
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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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 |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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