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General NPI Number Information
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NPI Number | 1598350100
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Entity Type | Organization
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Legal Business Name | MINYE CENTER FOR RECONSTRUCTIVE DENTISTRY & ORAL SURGERY, PC
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Dates
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Enumeration Date | 03/05/2021
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Last Update Date | 03/05/2021
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Provider Practice Location Address
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Address Line | 18981 VENTURA BLVD 2ND FLOOR, SUITE 200
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City | TARZANA
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State | CA
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Zip | 91356
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Country | US
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Telephone | 818-312-5819
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Fax |
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Provider Business Mailing Address
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Address Line | 25 HIGHLAND PARK VILLAGE BLDG 100 STE171
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City | DALLAS
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State | TX
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Zip | 75205
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CHIEF DENTAL OFFICER
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Name | DR. HELENA MALOUS MINYE
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Credential | DDS, MHCM
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Telephone | 818-312-5819
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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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