Provider Demographics
NPI:1689692303
Name:THE REGENTS OF THE UNIVERSITY OF CALIFORNIA
Entity Type:Organization
Organization Name:THE REGENTS OF THE UNIVERSITY OF CALIFORNIA
Other - Org Name:UCLA DENTAL ORAL SURGERY ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:A
Authorized Official - Middle Name:L
Authorized Official - Last Name:FELSENFELD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-825-0834
Mailing Address - Street 1:10833 LE CONTE AVE
Mailing Address - Street 2:A0-156
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095-3075
Mailing Address - Country:US
Mailing Address - Phone:310-825-0834
Mailing Address - Fax:310-794-2198
Practice Address - Street 1:10833 LE CONTE AVE # A0-156C
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-3075
Practice Address - Country:US
Practice Address - Phone:310-825-0834
Practice Address - Fax:310-794-2198
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FACULTY GROUP DENTAL PRACTICE AT UCLA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-18
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA245451223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG9195801OtherDENTI-CAL PROVIDER NUMBER
CAG9195801OtherDENTI-CAL PROVIDER NUMBER