Provider Demographics
NPI:1669593307
Name:CERVENY, ROBERTA JEAN (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERTA
Middle Name:JEAN
Last Name:CERVENY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2035 MEADOW VALLEY TER
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90039-3533
Mailing Address - Country:US
Mailing Address - Phone:323-662-3921
Mailing Address - Fax:
Practice Address - Street 1:16861 VENTURA BLVD
Practice Address - Street 2:#204
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-1708
Practice Address - Country:US
Practice Address - Phone:818-783-0408
Practice Address - Fax:818-783-9874
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA213541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice