MEDICARE: VAFA DENTAL CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center	52126	CA

General Provider Information

NPI Number	:	1063950244
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VAFA DENTAL CORP

Provider Business Mailing Address
First Line	:	7865 SANTA MONICA BLVD
Second Line	:
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90046-5344
Country	:	US
Telephone Number	:	323-654-2840
Fax Number	:

Provider Business Practice Location Address
First Line	:	7865 SANTA MONICA BLVD
Second Line	:
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90046-5344
Country	:	US
Telephone Number	:	323-654-2840
Fax Number	:

Authorized Official
Title or Position	:	TX COORDINATOR
Name	:	SANDY SCOTT
Credential	:
Telephone Number	:	310-201-9001

Provider Enumeration Date	:	02/07/2017
Last Update Date	:	02/07/2017

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Directions to “VAFA DENTAL CORP ” Practice Location

Language	Start Address	Practice Location

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