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General NPI Number Information
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NPI Number | 1659811065
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Entity Type | Organization
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Legal Business Name | WORMSER SMILES DENTAL OFFICE INC
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Dates
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Enumeration Date | 03/03/2017
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Last Update Date | 03/03/2017
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Provider Practice Location Address
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Address Line | 910 VIA DE LA PAZ SUITE 108
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City | PACIFIC PALISADES
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State | CA
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Zip | 90272-3515
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Country | US
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Telephone | 310-454-3732
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Fax | 310-459-2245
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Provider Business Mailing Address
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Address Line | 910 VIA DE LA PAZ 108
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City | PACIFIC PALISADES
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State | CA
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Zip | 90272-3515
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Country | US
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Telephone | 310-454-3732
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Fax | 310-459-2245
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Authorized Official
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Title or Position | OWNER
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Name | DR. RONALD PHILIP WORMSER
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Credential | D.M.D.
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Telephone | 310-454-3732
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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 | 28832
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License Number State | CA
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