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General NPI Number Information
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NPI Number | 1942490602
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Entity Type | Organization
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Legal Business Name | MID VALLEY DENTAL CARE-NORTHRIDGE
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Dates
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Enumeration Date | 07/30/2007
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Last Update Date | 08/21/2024
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Provider Practice Location Address
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Address Line | 19331 BUSINESS CENTER DRIVE SUITE 101
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City | NORTHRIDGE
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State | CA
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Zip | 91324
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Country | US
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Telephone | 818-886-3500
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Fax | 818-886-1733
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Provider Business Mailing Address
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Address Line | 19331 BUSINESS CENTER DRIVE SUITE 101
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City | NORTHRIDGE
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State | CA
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Zip | 91324
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Country | US
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Telephone | 818-886-3500
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Fax | 818-886-1733
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Authorized Official
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Title or Position | OWNER / PARTNER
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Name | DR. TERENCE KIEN-WA LAU
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Credential | D.D.S
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Telephone | 818-886-3500
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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