Provider Demographics
NPI:1114314903
Name:SB FAMILY MANAGEMENT, LLC
Entity Type:Organization
Organization Name:SB FAMILY MANAGEMENT, LLC
Other - Org Name:SB FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:M
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-892-9497
Mailing Address - Street 1:8940 WOODMAN AVE STE B
Mailing Address - Street 2:
Mailing Address - City:ARLETA
Mailing Address - State:CA
Mailing Address - Zip Code:91331-8027
Mailing Address - Country:US
Mailing Address - Phone:818-810-9983
Mailing Address - Fax:818-810-9983
Practice Address - Street 1:8940 WOODMAN AVE STE B
Practice Address - Street 2:
Practice Address - City:ARLETA
Practice Address - State:CA
Practice Address - Zip Code:91331-8027
Practice Address - Country:US
Practice Address - Phone:818-810-9983
Practice Address - Fax:818-810-9983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-20
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA381581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1967OtherDENTICAL