Provider Demographics
NPI:1891962759
Name:GINA DORFMAN, D.D.S., A.P.C.
Entity Type:Organization
Organization Name:GINA DORFMAN, D.D.S., A.P.C.
Other - Org Name:DENTISTRY FOR KIDS AND ADULTS, DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:DORFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:661-299-2525
Mailing Address - Street 1:18635 SOLEDAD CANYON RD STE 108
Mailing Address - Street 2:
Mailing Address - City:CANYON COUNTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91351-3723
Mailing Address - Country:US
Mailing Address - Phone:661-299-2525
Mailing Address - Fax:661-299-2591
Practice Address - Street 1:26457 BOUQUET CANYON RD
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91350-2396
Practice Address - Country:US
Practice Address - Phone:661-513-9393
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-09
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA474681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty