Provider Demographics
NPI:1174649065
Name:F. ENRIQUEZ & N.BRAJEVICH, PEDIATRIC DENTAL PARTNERSHIP
Entity Type:Organization
Organization Name:F. ENRIQUEZ & N.BRAJEVICH, PEDIATRIC DENTAL PARTNERSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:BRAJEVICH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-378-1283
Mailing Address - Street 1:23727 HAWTHORNE BLVD
Mailing Address - Street 2:SUITE 4B
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-5938
Mailing Address - Country:US
Mailing Address - Phone:310-378-1283
Mailing Address - Fax:310-378-3549
Practice Address - Street 1:23727 HAWTHORNE BLVD
Practice Address - Street 2:SUITE 4B
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-5938
Practice Address - Country:US
Practice Address - Phone:310-378-1283
Practice Address - Fax:310-378-3549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA410641223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty