=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508288499
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ELLIOT P. SCHLANG DDS INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/10/2014
-----------------------------------------------------
Last Update Date | 01/10/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 951 WESTWOOD BLVD
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90024-2904
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-824-2225
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 951 WESTWOOD BLVD
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90024-2904
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-824-2225
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST
-----------------------------------------------------
Name | DR. ELLIOT SCHLANG
-----------------------------------------------------
Credential | D.D.S
-----------------------------------------------------
Telephone | 310-451-4401
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number | 24337
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------