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General NPI Number Information
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NPI Number | 1659181717
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Entity Type | Organization
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Legal Business Name | NUGENT BARDI III DENTAL CORPORATION
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Dates
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Enumeration Date | 01/10/2025
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Last Update Date | 01/10/2025
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Provider Practice Location Address
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Address Line | 14444 VENTURA BLVD
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City | SHERMAN OAKS
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State | CA
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Zip | 91423-2607
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Country | US
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Telephone | 818-849-6756
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Fax |
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Provider Business Mailing Address
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Address Line | 3663 TORRANCE BLVD STE 3
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City | TORRANCE
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State | CA
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Zip | 90503-7814
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Country | US
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Telephone | 310-791-0666
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | HAREEM KIM
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Credential |
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Telephone | 619-254-8656
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number |
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License Number State |
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