Provider Demographics
NPI:1710429451
Name:DENTISTRY ON THE BLVD.
Entity Type:Organization
Organization Name:DENTISTRY ON THE BLVD.
Other - Org Name:HOLDEN CORPORATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JANELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLDEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-545-0855
Mailing Address - Street 1:1101 N SEPULVEDA BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-5948
Mailing Address - Country:US
Mailing Address - Phone:310-545-0855
Mailing Address - Fax:
Practice Address - Street 1:1101 N SEPULVEDA BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-5948
Practice Address - Country:US
Practice Address - Phone:310-545-0855
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-11
Last Update Date:2016-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41617122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty