Provider Demographics
NPI:1518639681
Name:DR. RUSEN VICTORVILLE FRIENDLY SMILES DENTAL INC.
Entity Type:Organization
Organization Name:DR. RUSEN VICTORVILLE FRIENDLY SMILES DENTAL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RARES
Authorized Official - Middle Name:DAN
Authorized Official - Last Name:RUSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:213-324-6000
Mailing Address - Street 1:15401 ANACAPA RD STE 3
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92392-2466
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15401 ANACAPA RD STE 3
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92392-2466
Practice Address - Country:US
Practice Address - Phone:213-324-6000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-28
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty