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General NPI Number Information
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NPI Number | 1467531889
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Entity Type | Organization
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Legal Business Name | MASOOD IMANUEL DMD A DENTAL CORPORATION
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Dates
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Enumeration Date | 11/05/2006
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Last Update Date | 06/12/2015
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Provider Practice Location Address
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Address Line | 14150 VAN NUYS BLVD SUITE 105
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City | ARLETA
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State | CA
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Zip | 91331-5114
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Country | US
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Telephone | 818-899-9999
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Fax | 818-897-0859
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Provider Business Mailing Address
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Address Line | 14150 VAN NUYS BLVD SUITE 105
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City | ARLETA
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State | CA
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Zip | 91331-5114
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Country | US
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Telephone | 818-899-9999
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Fax | 818-897-0859
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SIMON MASOOD IMANUEL
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Credential | DMD
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Telephone | 818-899-9999
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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 | 39418
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License Number State | CA
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