Provider Demographics
NPI:1346303195
Name:REGENTS OF UNIV. OF CALIFORNIA DENTAL ANESTHESIA SERVICE
Entity Type:Organization
Organization Name:REGENTS OF UNIV. OF CALIFORNIA DENTAL ANESTHESIA SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROFESSOR AND CHAIR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:ISAAC
Authorized Official - Last Name:GANZBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:310-825-9300
Mailing Address - Street 1:10833 LECONTE AVE
Mailing Address - Street 2:53-039 CHS
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095-1668
Mailing Address - Country:US
Mailing Address - Phone:310-825-9300
Mailing Address - Fax:310-352-0109
Practice Address - Street 1:10833 LECONTE AVE
Practice Address - Street 2:53-039 CHS
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-1668
Practice Address - Country:US
Practice Address - Phone:310-825-9300
Practice Address - Fax:877-352-0109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA607461223D0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0004XDental ProvidersDentistDentist AnesthesiologistGroup - Single Specialty