MEDICARE: KAPLAN DENTAL GROUP INNOVATIONS PC

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

General Provider Information

NPI Number	:	1649008400
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KAPLAN DENTAL GROUP INNOVATIONS PC

Provider Business Mailing Address
First Line	:	3932 WILSHIRE BLVD STE 102
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90010-3334
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1333 BROADWAY FL 3
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94612-1917
Country	:	US
Telephone Number	:	310-503-1729
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	GREGORY D KAPLAN
Credential	:	DDS
Telephone Number	:	310-503-7129

Provider Enumeration Date	:	07/23/2024
Last Update Date	:	07/23/2024

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