Provider Demographics
NPI:1114214269
Name:WARREN J. GEROSA, DDS,INC.
Entity Type:Organization
Organization Name:WARREN J. GEROSA, DDS,INC.
Other - Org Name:DOVE DENTAL SPA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WARREN
Authorized Official - Middle Name:J
Authorized Official - Last Name:GEROSA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-645-2886
Mailing Address - Street 1:8540 S SEPULVEDA BLVD STE 1212
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-3819
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8540 S SEPULVEDA BLVD STE 1212
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-3819
Practice Address - Country:US
Practice Address - Phone:310-645-2886
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-08
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA337121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty