Provider Demographics
NPI:1568838605
Name:GOTTLIEB, SIMCHA NEELI (DDS)
Entity Type:Individual
Prefix:
First Name:SIMCHA
Middle Name:NEELI
Last Name:GOTTLIEB
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8853 W OLYMPIC BLVD
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-3605
Mailing Address - Country:US
Mailing Address - Phone:310-657-6500
Mailing Address - Fax:310-657-6500
Practice Address - Street 1:8853 W OLYMPIC BLVD
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-3605
Practice Address - Country:US
Practice Address - Phone:310-657-6500
Practice Address - Fax:310-657-6500
Is Sole Proprietor?:No
Enumeration Date:2015-08-12
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA648111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice