Provider Demographics
NPI:1710357157
Name:A. H. SHEILY, D.D.S., A DENTAL CORPORATION
Entity Type:Organization
Organization Name:A. H. SHEILY, D.D.S., A DENTAL CORPORATION
Other - Org Name:CULVER MARINA DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:H
Authorized Official - Last Name:SHEILY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-822-6066
Mailing Address - Street 1:12756 W WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-2309
Mailing Address - Country:US
Mailing Address - Phone:310-822-6066
Mailing Address - Fax:310-574-8899
Practice Address - Street 1:12756 W WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-2309
Practice Address - Country:US
Practice Address - Phone:310-822-6066
Practice Address - Fax:310-574-8899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-28
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36833122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty