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General NPI Number Information
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NPI Number | 1639547698
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Entity Type | Organization
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Legal Business Name | VENTURA SPECIALTY DENTAL GROUP
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Dates
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Enumeration Date | 09/08/2015
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Last Update Date | 09/08/2015
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Provider Practice Location Address
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Address Line | 6325 TOPANGA CANYON BLVD SUITE 202
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City | WOODLAND HILLS
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State | CA
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Zip | 91367-2006
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Country | US
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Telephone | 818-703-7733
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Fax |
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Provider Business Mailing Address
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Address Line | 6325 TOPANGA CANYON BLVD SUITE 202
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City | WOODLAND HILLS
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State | CA
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Zip | 91367-2006
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Country | US
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Telephone | 818-703-7733
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Fax |
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Authorized Official
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Title or Position | OM
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Name | MS. DAISY GAGUI
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Credential |
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Telephone | 818-703-7733
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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 | 35503
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 35503
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License Number State | CA
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