Provider Demographics
NPI:1124186432
Name:HANITA SIDANA, DMD, INC.
Entity Type:Organization
Organization Name:HANITA SIDANA, DMD, INC.
Other - Org Name:GENTLE DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HANITA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIDANA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:818-825-8111
Mailing Address - Street 1:23852 STAGG ST
Mailing Address - Street 2:
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91304-6100
Mailing Address - Country:US
Mailing Address - Phone:818-825-8111
Mailing Address - Fax:818-337-2074
Practice Address - Street 1:7138 SHOUP AVE STE B7&B8
Practice Address - Street 2:
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307-2383
Practice Address - Country:US
Practice Address - Phone:818-883-7070
Practice Address - Fax:818-883-7031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA533361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG93684-01Medicaid