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General NPI Number Information
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NPI Number | 1891337762
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Entity Type | Organization
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Legal Business Name | EDA METHASANI DDS DENTAL CORP
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Dates
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Enumeration Date | 10/11/2019
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Last Update Date | 10/26/2019
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Provider Practice Location Address
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Address Line | 4740 INGLEWOOD BLVD
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City | CULVER CITY
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State | CA
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Zip | 90230-5824
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Country | US
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Telephone | 310-313-1063
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Fax | 310-398-5681
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Provider Business Mailing Address
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Address Line | 4740 INGLEWOOD BLVD
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City | CULVER CITY
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State | CA
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Zip | 90230-5824
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Country | US
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Telephone | 310-313-1063
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Fax | 310-398-5681
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. EDA JOKIC
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Credential | DDS
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Telephone | 310-313-1063
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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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