Provider Demographics
NPI:1629134853
Name:MARGARITA METRIKINA, DDS, A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:MARGARITA METRIKINA, DDS, A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARGARITA
Authorized Official - Middle Name:
Authorized Official - Last Name:METRIKINA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:323-876-9222
Mailing Address - Street 1:7315 W SUNSET BLVD
Mailing Address - Street 2:STE. B
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90046-3421
Mailing Address - Country:US
Mailing Address - Phone:323-876-9222
Mailing Address - Fax:323-883-0207
Practice Address - Street 1:7315 W SUNSET BLVD
Practice Address - Street 2:STE. B
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90046-3421
Practice Address - Country:US
Practice Address - Phone:323-876-9222
Practice Address - Fax:323-883-0207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46888261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG93322Medicaid