Provider Demographics
NPI:1679784581
Name:IOVANNA GOLDENBERG,DDS & KIRA MEYERKOVA,DDS A PROFESSIONAL DENTAL CORP
Entity Type:Organization
Organization Name:IOVANNA GOLDENBERG,DDS & KIRA MEYERKOVA,DDS A PROFESSIONAL DENTAL CORP
Other - Org Name:SUNLAND FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:IOVANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-352-8888
Mailing Address - Street 1:8522 FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:SUNLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91040-1951
Mailing Address - Country:US
Mailing Address - Phone:818-352-8888
Mailing Address - Fax:818-352-4451
Practice Address - Street 1:8522 FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:SUNLAND
Practice Address - State:CA
Practice Address - Zip Code:91040-1951
Practice Address - Country:US
Practice Address - Phone:818-352-8888
Practice Address - Fax:818-352-4451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA443131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG9343201Medicaid