Provider Demographics
NPI:1144437898
Name:DE VELA DENTAL CORPORATION
Entity type:Organization
Organization Name:DE VELA DENTAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ARMAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:DE VELA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:323-462-3305
Mailing Address - Street 1:5300 SANTA MONICA BLVD
Mailing Address - Street 2:SUITE 404
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90029-1131
Mailing Address - Country:US
Mailing Address - Phone:323-462-3305
Mailing Address - Fax:323-462-3327
Practice Address - Street 1:5300 SANTA MONICA BLVD
Practice Address - Street 2:SUITE 404
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90029-1131
Practice Address - Country:US
Practice Address - Phone:323-462-3305
Practice Address - Fax:323-462-3327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA405721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty