Provider Demographics
NPI:1417955816
Name:DITTO, MARY A (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:A
Last Name:DITTO
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 1:7411 TOPANGA CANYON BLVD
Mailing Address - Street 2:
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91303-1211
Mailing Address - Country:US
Mailing Address - Phone:818-346-5424
Mailing Address - Fax:818-346-9132
Practice Address - Street 1:7411 TOPANGA CANYON BLVD
Practice Address - Street 2:
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91303-1211
Practice Address - Country:US
Practice Address - Phone:818-346-5424
Practice Address - Fax:818-346-9132
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-09
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA256961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice