Provider Demographics
NPI:1154470078
Name:GOTTSCHALK, HENRY WILLIAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:WILLIAM
Last Name:GOTTSCHALK
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 1:18610 RINGLING ST.
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356
Mailing Address - Country:US
Mailing Address - Phone:818-987-5705
Mailing Address - Fax:818-609-1183
Practice Address - Street 1:18610 RINGLING ST.
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356
Practice Address - Country:US
Practice Address - Phone:818-987-5705
Practice Address - Fax:818-609-1183
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA312701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice