Provider Demographics
NPI:1568234730
Name:UDAS DENTAL CORP
Entity Type:Organization
Organization Name:UDAS DENTAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:BEN
Authorized Official - Middle Name:
Authorized Official - Last Name:UDAS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:857-206-3875
Mailing Address - Street 1:1274 N CRESCENT HEIGHTS BLVD APT 213
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90046-5060
Mailing Address - Country:US
Mailing Address - Phone:857-206-3875
Mailing Address - Fax:
Practice Address - Street 1:2102 ARTESIA BLVD
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90504-3003
Practice Address - Country:US
Practice Address - Phone:424-271-4714
Practice Address - Fax:424-488-7724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental