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General NPI Number Information
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NPI Number | 1861687196
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Entity Type | Organization
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Legal Business Name | VANDANA MASTER DDS A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 09/10/2007
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Last Update Date | 09/10/2007
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Provider Practice Location Address
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Address Line | 166 N MOORPARK RD SUITE #202
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City | THOUSAND OAKS
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State | CA
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Zip | 91360-4405
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Country | US
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Telephone | 805-497-7505
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Fax | 805-497-3326
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Provider Business Mailing Address
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Address Line | 166 N MOORPARK RD SUITE #202
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City | THOUSAND OAKS
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State | CA
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Zip | 91360-4405
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Country | US
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Telephone | 805-497-7505
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Fax | 805-497-3326
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. VANDANA(VANNA) MASTER
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Credential | D.D.S.
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Telephone | 805-497-7505
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 39042
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License Number State | CA
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