MEDICARE: DR. RICHARD PENAMANTE GUSILATAR 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	54561	CA

General Provider Information

NPI Number	:	1861560443
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD PENAMANTE GUSILATAR DDS

Provider Business Mailing Address
First Line	:	20644 VENTURA BLVD
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91364-2314
Country	:	US
Telephone Number	:	818-887-8900
Fax Number	:	818-887-8976

Provider Business Practice Location Address
First Line	:	20644 VENTURA BLVD
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91364-2314
Country	:	US
Telephone Number	:	818-887-8900
Fax Number	:	818-887-8976

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/01/2006
Last Update Date	:	06/29/2022

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