Provider Demographics
NPI:1558014639
Name:ME DENTAL SPA
Entity Type:Organization
Organization Name:ME DENTAL SPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DENIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MUSTEDANAGIC
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:423-314-7497
Mailing Address - Street 1:718 N CROFT AVE APT 303
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90069-5350
Mailing Address - Country:US
Mailing Address - Phone:423-314-7497
Mailing Address - Fax:
Practice Address - Street 1:9201 W SUNSET BLVD STE 212
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90069-3703
Practice Address - Country:US
Practice Address - Phone:423-314-7497
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-30
Last Update Date:2022-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental