Provider Demographics
NPI:1518062124
Name:GOREN, VALENTINA (DDS)
Entity Type:Individual
Prefix:
First Name:VALENTINA
Middle Name:
Last Name:GOREN
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 1:14515 1/2 VICTORY BLVD
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91411-1619
Mailing Address - Country:US
Mailing Address - Phone:818-902-9999
Mailing Address - Fax:818-902-9393
Practice Address - Street 1:14515 1/2 VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91411-1619
Practice Address - Country:US
Practice Address - Phone:818-902-9999
Practice Address - Fax:818-902-9393
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA532161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice