Provider Demographics
NPI:1508221292
Name:21 CENTURY DENTAL & SLEEP CENTER
Entity Type:Organization
Organization Name:21 CENTURY DENTAL & SLEEP CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:BARRERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-255-3712
Mailing Address - Street 1:5217 HOLLYWOOD BLVD APT 316
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-4964
Mailing Address - Country:US
Mailing Address - Phone:817-805-2262
Mailing Address - Fax:
Practice Address - Street 1:5217 HOLLYWOOD BLVD APT 316
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-4964
Practice Address - Country:US
Practice Address - Phone:817-805-2262
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-22
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29645251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare