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General NPI Number Information
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NPI Number | 1750588018
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Entity Type | Organization
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Legal Business Name | DENTAL SPECIALTY SERVICE
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Dates
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Enumeration Date | 06/29/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6320 CANOGA AVE STE 1500
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City | WOODLAND HILLS
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State | CA
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Zip | 91367-2563
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Country | US
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Telephone | 800-768-4879
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 4571
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City | VALLEY VILLAGE
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State | CA
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Zip | 91617-0571
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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 | OWNER
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Name | YAN WANG
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Credential |
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Telephone | 800-768-4879
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 17984
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License Number State | CA
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