| Porter Ranch Dental Studio | |
|
11200 Corbin Ave Ste 208 Porter Ranch CA 91326-4120 | |
| (614) 309-1050 | |
| (818) 368-8544 |
| Full Name | Porter Ranch Dental Studio |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 11200 Corbin Ave Ste 208, Porter Ranch, California |
| Authorized Official Name and Position | Aleksei Dolgov (OWNER) |
| Authorized Official Contact | 8183688522 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Porter Ranch Dental Studio 11200 Corbin Ave Ste 208 Porter Ranch CA 91326-4120 Ph: (614) 309-1050 | Porter Ranch Dental Studio 11200 Corbin Ave Ste 208 Porter Ranch CA 91326-4120 Ph: (614) 309-1050 |
| NPI Number | 1134828148 |
|---|---|
| Provider Enumeration Date | 02/28/2023 |
| Last Update Date | 02/28/2023 |
| Certification Date | 02/28/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134828148 | NPI | - | NPPES |
| 1316514565 | Other | DENTAL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | () | Primary |
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