Basic Information
| Provider Information | |||||||||
| NPI: | 1619528064 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PESSAH DENTAL CORPORATION | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | DOWNEY MODERN DENTISTRY DENTAL GROUP | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 920050 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 753920050 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7148458500 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 12214 LAKEWOOD BLVD STE 102 | ||||||||
| Address2: | |||||||||
| City: | DOWNEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902422663 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5622732050 | ||||||||
| FaxNumber: | 5622479788 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2019 | ||||||||
| LastUpdateDate: | 08/05/2022 | ||||||||
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| AuthorizedOfficialLastName: | PESSAH | ||||||||
| AuthorizedOfficialFirstName: | ARIELLA | ||||||||
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| AuthorizedOfficialTitleorPosition: | GP/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5622732050 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DDS | ||||||||
| NPICertificationDate: | 08/05/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Dental Providers | Dentist |
No ID Information.