Provider Demographics
NPI:1982214862
Name:BRASLAVSKY DENTAL CORPORATION
Entity Type:Organization
Organization Name:BRASLAVSKY DENTAL CORPORATION
Other - Org Name:AMERICAN DENTAL OFFICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRASLAVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-474-2253
Mailing Address - Street 1:15545 SAN FERNANDO MISSION BLVD
Mailing Address - Street 2:
Mailing Address - City:MISSION HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91345-1394
Mailing Address - Country:US
Mailing Address - Phone:818-474-2253
Mailing Address - Fax:
Practice Address - Street 1:15545 SAN FERNANDO MISSION BLVD
Practice Address - Street 2:
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91345-1394
Practice Address - Country:US
Practice Address - Phone:818-474-2253
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-05
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty