Provider Demographics
NPI:1558575621
Name:DONTSOVA, VICTORIA (DDS)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:DONTSOVA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:VIKTORIYA
Other - Middle Name:
Other - Last Name:DONTSOVA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:18440 HATTERAS ST APT 32
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-1978
Mailing Address - Country:US
Mailing Address - Phone:818-757-1179
Mailing Address - Fax:818-757-1179
Practice Address - Street 1:18440 HATTERAS ST APT 32
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-1978
Practice Address - Country:US
Practice Address - Phone:818-757-1179
Practice Address - Fax:818-757-1179
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA470711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice