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General NPI Number Information
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NPI Number | 1659414142
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Entity Type | Organization
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Legal Business Name | ORTHOODNTICS ONLY
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Dates
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Enumeration Date | 02/14/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 11633 HAWTHORNE BLVD SUITE #500
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City | HAWTHORNE
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State | CA
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Zip | 90250-2321
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Country | US
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Telephone | 310-644-4412
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Fax | 310-644-7355
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Provider Business Mailing Address
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Address Line | 11633 HAWTHORNE BLVD SUITE #500
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City | HAWTHORNE
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State | CA
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Zip | 90250-2321
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Country | US
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Telephone | 310-644-4412
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Fax | 310-644-7355
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. FAREL A. ROSENBERG
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Credential | DDS,DMD
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Telephone | 310-644-4412
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | 17997
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License Number State | CA
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