MEDICARE: POOJA ANISH ASWANI,A 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
1	261QD0000X	Dental Clinic/Center	49282	CA

General Provider Information

NPI Number	:	1588051593
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POOJA ANISH ASWANI,A DENTAL CORPORATION

Provider Business Mailing Address
First Line	:	7901 SANTA MONICA BLVD
Second Line	:	#111
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90046-5177
Country	:	US
Telephone Number	:	323-822-1222
Fax Number	:	323-822-1322

Provider Business Practice Location Address
First Line	:	7901 SANTA MONICA BLVD
Second Line	:	#111
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90046-5177
Country	:	US
Telephone Number	:	323-822-1222
Fax Number	:	323-822-1322

Authorized Official
Title or Position	:	OWNER
Name	:	POOJA ASWANI
Credential	:	DDS
Telephone Number	:	310-869-5527

Provider Enumeration Date	:	04/17/2015
Last Update Date	:	04/17/2015

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