Provider Demographics
NPI:1114084308
Name:VON POWER, PETER (DDS, DMD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:
Last Name:VON POWER
Suffix:
Gender:M
Credentials:DDS, DMD
Other - Prefix:
Other - First Name:PETER
Other - Middle Name:
Other - Last Name:OVTSCHAROV
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2110 E CESAR E CHAVEZ AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-1823
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2110 E CESAR E CHAVEZ AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-1823
Practice Address - Country:US
Practice Address - Phone:323-262-1555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA343981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG9388801Medicaid
CABO6562347OtherDEA REGISTRATION NUMBER