Provider Demographics
NPI:1558081430
Name:JEFFREY PRONILOFF, DDS, INC
Entity Type:Organization
Organization Name:JEFFREY PRONILOFF, DDS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:PRONILOFF
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-437-5060
Mailing Address - Street 1:4332 COLDWATER CANYON AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-1470
Mailing Address - Country:US
Mailing Address - Phone:818-437-5060
Mailing Address - Fax:
Practice Address - Street 1:1960 SEQUOIA AVE STE 1
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93063-3176
Practice Address - Country:US
Practice Address - Phone:805-584-3999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-31
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty