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General NPI Number Information
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NPI Number | 1700037710
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Entity Type | Organization
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Legal Business Name | GEORGE A MARANON ORAL MAXILLOFACIAL SURGERY
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Dates
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Enumeration Date | 10/08/2008
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Last Update Date | 10/08/2008
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Provider Practice Location Address
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Address Line | 18411 CLARK ST SUITE # 204
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City | TARZANA
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State | CA
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Zip | 91356-3506
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Country | US
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Telephone | 818-344-0110
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Fax | 818-344-0110
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Provider Business Mailing Address
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Address Line | 18411 CLARK ST SUITE # 204
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City | TARZANA
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State | CA
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Zip | 91356-3506
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Country | US
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Telephone | 818-344-0110
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Fax | 818-344-0110
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Authorized Official
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Title or Position | OWNER
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Name | MR. GEORGE A. MARANON
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Credential | D.D.S.
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Telephone | 818-344-0110
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | D32127
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License Number State | CA
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