| Fundaminsky Oral Facial Dds Inc | |
|
9615 Brighton Way Ste 216 Beverly Hills CA 90210-5118 | |
| (310) 278-0814 | |
| Not Available |
| Full Name | Fundaminsky Oral Facial Dds Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 9615 Brighton Way Ste 216, Beverly Hills, California |
| Authorized Official Name and Position | Gennady M Fundaminsky (PRESIDENT) |
| Authorized Official Contact | 3108011296 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Fundaminsky Oral Facial Dds Inc 9615 Brighton Way Ste 216 Beverly Hills CA 90210-5118 Ph: () - | Fundaminsky Oral Facial Dds Inc 9615 Brighton Way Ste 216 Beverly Hills CA 90210-5118 Ph: (310) 278-0814 |
| NPI Number | 1629784046 |
|---|---|
| Provider Enumeration Date | 01/30/2023 |
| Last Update Date | 01/30/2023 |
| Medicare PECOS PAC ID | 6800260878 |
|---|---|
| Medicare Enrollment ID | O20230315001663 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629784046 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
| Provider Name | Gennady M Fundaminsky |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1295956357 PECOS PAC ID: 8729214325 Enrollment ID: I20131203001276 |
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