Provider Demographics
NPI:1326445883
Name:ENCINO TOTAL DENTISTRY
Entity Type:Organization
Organization Name:ENCINO TOTAL DENTISTRY
Other - Org Name:ENCINO TOTAL DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INSURANCE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:LEONOR
Authorized Official - Middle Name:
Authorized Official - Last Name:PINEDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-450-0116
Mailing Address - Street 1:15840 VENTURA BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2933
Mailing Address - Country:US
Mailing Address - Phone:818-574-7450
Mailing Address - Fax:661-273-9572
Practice Address - Street 1:16260 VENTURA BLVD STE 410
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2239
Practice Address - Country:US
Practice Address - Phone:818-904-1444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GILBERT H. SNOW DDS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-11-28
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1223D0001X
CA193851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223D0001XDental ProvidersDentistDental Public HealthGroup - Multi-Specialty