Provider Demographics
NPI:1093930240
Name:GOTTLIEB, HOWARD JOSEPH (DDS)
Entity Type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:JOSEPH
Last Name:GOTTLIEB
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20315 VENTURA BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-2449
Mailing Address - Country:US
Mailing Address - Phone:818-439-5484
Mailing Address - Fax:
Practice Address - Street 1:20315 VENTURA BLVD STE C
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-2449
Practice Address - Country:US
Practice Address - Phone:818-439-5484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-14
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA272881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice