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General NPI Number Information
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NPI Number | 1891984928
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Entity Type | Organization
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Legal Business Name | IDA GANAPOLSKY, D.D.S. A PROFESSIONAL DENTAL CORP.
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Dates
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Enumeration Date | 10/15/2007
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Last Update Date | 10/15/2007
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Provider Practice Location Address
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Address Line | 3356 E OLYMPIC BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90023-3724
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Country | US
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Telephone | 323-269-5221
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Fax | 323-269-5730
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Provider Business Mailing Address
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Address Line | 3356 E OLYMPIC BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90023-3724
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Country | US
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Telephone | 323-269-5221
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Fax | 323-269-5730
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. ROSEMARY GARCIA
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Credential |
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Telephone | 323-269-5221
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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 | 34103
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License Number State | CA
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