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General NPI Number Information
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NPI Number | 1891962759
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Entity Type | Organization
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Legal Business Name | GINA DORFMAN, D.D.S., A.P.C.
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Dates
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Enumeration Date | 05/09/2008
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Last Update Date | 05/09/2008
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Provider Practice Location Address
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Address Line | 26457 BOUQUET CANYON RD
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City | SANTA CLARITA
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State | CA
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Zip | 91350-2396
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Country | US
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Telephone | 661-513-9393
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Fax |
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Provider Business Mailing Address
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Address Line | 18635 SOLEDAD CANYON RD STE 108
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City | CANYON COUNTRY
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State | CA
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Zip | 91351-3723
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Country | US
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Telephone | 661-299-2525
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Fax | 661-299-2591
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GINA DORFMAN
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Credential | D.D.S.
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Telephone | 661-299-2525
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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 | 47468
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License Number State | CA
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