Provider Demographics
NPI:1750509881
Name:ART DENTAL
Entity type:Organization
Organization Name:ART DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALLA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAPOPORT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:661-949-8288
Mailing Address - Street 1:919 W AVENUE J STE C
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-3432
Mailing Address - Country:US
Mailing Address - Phone:661-949-8288
Mailing Address - Fax:
Practice Address - Street 1:919 W AVENUE J STE C
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-3432
Practice Address - Country:US
Practice Address - Phone:661-949-8288
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48358122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA47444OtherDENTAL LICENSE
CA43604OtherDENTAL LICENSE
CA43605OtherDENTAL LICENSE NUMBER
CA48358OtherDENTAL LICENSE