MEDICARE: DAVID VAYSLEYB DDS

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	122300000X	Dentist	61841	CA

General Provider Information

NPI Number	:	1194192229
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVID VAYSLEYB DDS

Provider Business Mailing Address
First Line	:	10673 W PICO BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-2221
Country	:	US
Telephone Number	:	310-474-1800
Fax Number	:	310-474-1883

Provider Business Practice Location Address
First Line	:	10673 W PICO BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-2221
Country	:	US
Telephone Number	:	310-474-1800
Fax Number	:	310-474-1883

Authorized Official
Title or Position	:	OWNER
Name	:	DAVIV VAYSLEYB
Credential	:	DDS
Telephone Number	:	310-474-1800

Provider Enumeration Date	:	08/24/2015
Last Update Date	:	08/24/2015

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