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General NPI Number Information
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NPI Number | 1710177514
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Entity Type | Organization
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Legal Business Name | SVETLANA HAMER A PROF DENTAL CORP
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Dates
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Enumeration Date | 07/27/2007
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Last Update Date | 05/19/2014
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Provider Practice Location Address
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Address Line | 777 TRUMAN ST., SUITE 107
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City | SAN FERNANDO
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State | CA
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Zip | 91340-3374
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Country | US
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Telephone | 818-838-1313
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Fax |
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Provider Business Mailing Address
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Address Line | 777 TRUMAN ST., SUITE 107
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City | SAN FERNANDO
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State | CA
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Zip | 91340-3374
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | SVETLANA HAMER
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Credential | D.D.S.
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Telephone | 818-838-1313
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 43605
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License Number State | CA
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