Provider Demographics
NPI:1013101690
Name:WESTCHESTER PEDIATRIC DENTISTRY
Entity type:Organization
Organization Name:WESTCHESTER PEDIATRIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTIE
Authorized Official - Middle Name:RACHELLE
Authorized Official - Last Name:BURNETT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-216-5754
Mailing Address - Street 1:8540 S SEPULVEDA BLVD STE 710
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-3818
Mailing Address - Country:US
Mailing Address - Phone:310-216-5754
Mailing Address - Fax:
Practice Address - Street 1:8540 S SEPULVEDA BLVD STE 710
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-3818
Practice Address - Country:US
Practice Address - Phone:310-216-5754
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-28
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA473521223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty