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NPI Code Detail

MEDICARE: MAKHSUDOVA DENTAL CORPORATION

MEDICARE: MAKHSUDOVA DENTAL CORPORATION
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
11223G0001XGeneral Practice DentistryG89888-01CA

General Provider Information

NPI Number : 1437224664
Entity Type Code : Organization
Provider Name (Legal Business Name) : MAKHSUDOVA DENTAL CORPORATION
Provider Business Mailing Address
First Line : 4905 HOLLYWOOD BLVD
Second Line :
City : LOS ANGELES
State : CA
Zip : 90027-6101
Country : US
Telephone Number : 323-461-9942
Fax Number :
Provider Business Practice Location Address
First Line : 4905 HOLLYWOOD BLVD
Second Line :
City : LOS ANGELES
State : CA
Zip : 90027-6101
Country : US
Telephone Number : 323-461-9942
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : LALA MAKHSUDOVA
Credential :
Telephone Number : 323-461-9942
Provider Enumeration Date : 11/22/2006
Last Update Date : 07/10/2008

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Directions to “MAKHSUDOVA DENTAL CORPORATION ” Practice Location

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