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General NPI Number Information
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NPI Number | 1538850680
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Entity Type | Organization
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Legal Business Name | MACY POUR DDS INC
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Dates
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Enumeration Date | 05/18/2023
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Last Update Date | 05/18/2023
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Provider Practice Location Address
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Address Line | 5658 SEPULVEDA BLVD STE 204
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City | SHERMAN OAKS
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State | CA
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Zip | 91411-2927
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Country | US
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Telephone | 818-988-9959
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Fax |
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Provider Business Mailing Address
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Address Line | 11767 W SUNSET BLVD APT 104
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City | LOS ANGELES
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State | CA
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Zip | 90049-2991
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Country | US
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Telephone | 310-906-8972
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | MACY POUR
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Credential | DDS
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Telephone | 310-906-8972
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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 |
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License Number State |
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