Provider Demographics
NPI:1013637008
Name:CARSON-AUERBACH AIRWAY CENTERED DENTAL GROUP PC
Entity Type:Organization
Organization Name:CARSON-AUERBACH AIRWAY CENTERED DENTAL GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CARSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-889-0400
Mailing Address - Street 1:30200 AGOURA RD STE 270
Mailing Address - Street 2:
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-5434
Mailing Address - Country:US
Mailing Address - Phone:818-889-0400
Mailing Address - Fax:
Practice Address - Street 1:30200 AGOURA RD STE 270
Practice Address - Street 2:
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-5434
Practice Address - Country:US
Practice Address - Phone:818-889-0400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-30
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty