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General NPI Number Information
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NPI Number | 1851992481
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Entity Type | Organization
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Legal Business Name | CENTINELA JOSEPH DENTAL GROUP
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Dates
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Enumeration Date | 11/02/2020
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Last Update Date | 11/02/2020
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Provider Practice Location Address
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Address Line | 6907 LA TIJERA BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90045-1906
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Country | US
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Telephone | 310-645-0336
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Fax | 310-645-9250
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Provider Business Mailing Address
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Address Line | 2934 1/2 BEVERLY GLEN CIRCLE #451 451
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City | LOS ANGELES
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State | CA
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Zip | 90077-1724
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Country | US
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Telephone | 310-695-1589
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Fax | 818-782-0402
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | JOESPH AZIZI
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Credential |
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Telephone | 310-466-9571
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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