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General NPI Number Information
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NPI Number | 1528192317
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Entity Type | Organization
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Legal Business Name | DAVIS FAMILI DDS MAGD INC
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Dates
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Enumeration Date | 03/15/2007
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Last Update Date | 07/10/2008
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Provider Practice Location Address
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Address Line | 11500 W OLYMPIC BLVD #508
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City | LOS ANGELES
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State | CA
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Zip | 90064
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Country | US
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Telephone | 310-477-7744
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Fax | 310-477-1144
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Provider Business Mailing Address
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Address Line | 11500 W OLYMPIC BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90064
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Country | US
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Telephone | 310-477-7744
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Fax | 310-477-1144
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DAVE FAMILI
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Credential | DDS
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Telephone | 310-477-7744
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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 | 30499
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License Number State | CA
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