Provider Demographics
NPI:1497499644
Name:DIANA E ZSCHASCHEL, DDS A PROFESSIONAL DENTAL CORP
Entity Type:Organization
Organization Name:DIANA E ZSCHASCHEL, DDS A PROFESSIONAL DENTAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:E
Authorized Official - Last Name:ZSCHASCHEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-854-6102
Mailing Address - Street 1:11600 WILSHIRE BLVD STE 220
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-1782
Mailing Address - Country:US
Mailing Address - Phone:310-854-6102
Mailing Address - Fax:310-854-6161
Practice Address - Street 1:11600 WILSHIRE BLVD STE 220
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-1782
Practice Address - Country:US
Practice Address - Phone:310-854-6102
Practice Address - Fax:310-854-6161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-25
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental