Provider Demographics
NPI:1972252682
Name:PINAR WAGNER DENTAL PARTNERSHIP
Entity Type:Organization
Organization Name:PINAR WAGNER DENTAL PARTNERSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:DARYL JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:DELACRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-268-5665
Mailing Address - Street 1:8733 BEVERLY BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90048-1844
Mailing Address - Country:US
Mailing Address - Phone:310-659-1000
Mailing Address - Fax:
Practice Address - Street 1:8733 BEVERLY BLVD STE 202
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90048-1844
Practice Address - Country:US
Practice Address - Phone:310-659-1000
Practice Address - Fax:310-659-3536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-21
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental