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General NPI Number Information
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NPI Number | 1447623525
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Entity Type | Organization
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Legal Business Name | SERGEY LOKOT DENTAL CORPORATION
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Dates
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Enumeration Date | 11/11/2015
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Last Update Date | 11/11/2015
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Provider Practice Location Address
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Address Line | 5363 BALBOA BLVD STE 233
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City | ENCINO
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State | CA
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Zip | 91316-2824
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Country | US
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Telephone | 818-788-4424
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Fax | 818-788-4426
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Provider Business Mailing Address
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Address Line | 5363 BALBOA BLVD STE 233
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City | ENCINO
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State | CA
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Zip | 91316-2824
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Country | US
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Telephone | 818-788-4424
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Fax | 818-788-4426
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. NATALIE KOLKOVICH
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Credential |
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Telephone | 818-788-4424
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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 | 58921
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License Number State | CA
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