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General NPI Number Information
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NPI Number | 1518370931
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Entity Type | Organization
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Legal Business Name | VLADIMIR VYSOTSKY DENTAL CORP
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Dates
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Enumeration Date | 06/03/2014
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Last Update Date | 11/14/2014
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Provider Practice Location Address
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Address Line | 19520 NORDHOFF ST SUITE #17
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City | NORTHRIDGE
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State | CA
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Zip | 91324-2428
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Country | US
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Telephone | 818-701-9400
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Fax | 818-701-9083
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Provider Business Mailing Address
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Address Line | 19520 NORDHOFF ST SUITE #17
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City | NORTHRIDGE
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State | CA
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Zip | 91324-2428
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Country | US
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Telephone | 818-701-9400
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Fax | 818-701-9083
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Authorized Official
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Title or Position | OWNER
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Name | VLADIMIR VYSOTSKY
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Credential | DDS
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Telephone | 818-701-9400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State | CA
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