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General NPI Number Information
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NPI Number | 1992028575
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Entity Type | Organization
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Legal Business Name | MANDALAY CREST MANAGEMENT GROUP INC
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Dates
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Enumeration Date | 03/10/2010
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Last Update Date | 07/19/2010
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Provider Practice Location Address
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Address Line | 18663 VENTURA BLVD #200
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City | TARZANA
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State | CA
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Zip | 91356-4197
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Country | US
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Telephone | 805-479-8706
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Fax |
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Provider Business Mailing Address
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Address Line | 4924 BALBOA BLVD #223
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City | ENCINO
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State | CA
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Zip | 91316-3402
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Country | US
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Telephone | 805-479-8706
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. FLOYD JESSE CAWTHON III
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Credential | DDS
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Telephone | 805-479-8706
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 32043
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License Number State | CA
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