Provider Demographics
NPI:1174681621
Name:TERNOVSKY, SUSANNE LINDA (DDS)
Entity Type:Individual
Prefix:DR
First Name:SUSANNE
Middle Name:LINDA
Last Name:TERNOVSKY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11704 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 290
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025
Mailing Address - Country:US
Mailing Address - Phone:310-473-2099
Mailing Address - Fax:310-473-4434
Practice Address - Street 1:11704 WILSHIRE BLVD
Practice Address - Street 2:SUITE 290
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025
Practice Address - Country:US
Practice Address - Phone:310-473-2099
Practice Address - Fax:310-473-4434
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice