Provider Demographics
NPI:1386868503
Name:SUSAN MANAVI, DDS, INC
Entity Type:Organization
Organization Name:SUSAN MANAVI, DDS, INC
Other - Org Name:CHOICE DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MAANAVI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-644-4000
Mailing Address - Street 1:12730 HAWTHORNE BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-3919
Mailing Address - Country:US
Mailing Address - Phone:310-644-4000
Mailing Address - Fax:310-644-3232
Practice Address - Street 1:12730 HAWTHORNE BLVD STE D
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-3919
Practice Address - Country:US
Practice Address - Phone:310-644-4000
Practice Address - Fax:310-644-3232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA351411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty