Provider Demographics
NPI:1447475868
Name:M VOLOSHIN DDS PROFESSIONAL DENTAL CORPORATION
Entity type:Organization
Organization Name:M VOLOSHIN DDS PROFESSIONAL DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JACOB
Authorized Official - Last Name:VOLOSHIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:323-869-8811
Mailing Address - Street 1:865 N WILCOX AVE
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640
Mailing Address - Country:US
Mailing Address - Phone:323-869-8811
Mailing Address - Fax:323-869-8833
Practice Address - Street 1:865 N WILCOX AVE
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640
Practice Address - Country:US
Practice Address - Phone:323-869-8811
Practice Address - Fax:323-869-8833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41570122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty