Provider Demographics
NPI:1982132239
Name:ONWUEGBUSI AND VAN HOUTEN DENTAL PARTNERSHIP
Entity Type:Organization
Organization Name:ONWUEGBUSI AND VAN HOUTEN DENTAL PARTNERSHIP
Other - Org Name:BAYVIEW PEDIATRIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TERA
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN HOUTEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-775-0645
Mailing Address - Street 1:500 S SEPULVEDA BLVD STE 301
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-6976
Mailing Address - Country:US
Mailing Address - Phone:310-683-5576
Mailing Address - Fax:310-683-4648
Practice Address - Street 1:500 S SEPULVEDA BLVD STE 301
Practice Address - Street 2:
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-6976
Practice Address - Country:US
Practice Address - Phone:310-683-5576
Practice Address - Fax:310-683-4648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty