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General NPI Number Information
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NPI Number | 1730650862
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Entity Type | Organization
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Legal Business Name | MAANAVI FAMILY DENTISTRY, INC.
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Dates
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Enumeration Date | 12/16/2018
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Last Update Date | 02/24/2020
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Provider Practice Location Address
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Address Line | 161 S HACIENDA BLVD
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City | CITY OF INDUSTRY
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State | CA
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Zip | 91745-1102
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Country | US
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Telephone | 714-926-0327
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Fax |
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Provider Business Mailing Address
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Address Line | 161 S HACIENDA BLVD
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City | CITY OF INDUSTRY
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State | CA
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Zip | 91745-1102
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Country | US
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Telephone | 714-926-0327
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Fax |
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Authorized Official
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Title or Position | MANAGING DENTIST
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Name | DR. SUSAN MAANAVI
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Credential | DDS
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Telephone | 626-968-9601
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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 |
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License Number State |
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