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General NPI Number Information
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NPI Number | 1497977904
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Entity Type | Organization
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Legal Business Name | FLOYD CAWTHON DENTAL CORPORATION
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 01/16/2009
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Provider Practice Location Address
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Address Line | 8635 W. 3RD STREET SUITE 255-W
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City | LOS ANGELES
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State | CA
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Zip | 90048-6113
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Country | US
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Telephone | 310-659-5430
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Fax |
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Provider Business Mailing Address
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Address Line | 4924 BALBOA BLVD #223
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City | ENCINO
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State | CA
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Zip | 91316-3402
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Country | US
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Telephone | 310-659-5430
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. FLOYD JESSE CAWTHON III
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Credential | D.D.S.
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Telephone | 310-659-5430
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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 | DG32043
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License Number State | CA
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