Provider Demographics
NPI:1548474984
Name:ROBERT S. VON WENDT DENTAL CORPORATION
Entity type:Organization
Organization Name:ROBERT S. VON WENDT DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:VON WENDT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:323-466-8607
Mailing Address - Street 1:321 N LARCHMONT BLVD STE 722
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90004-6407
Mailing Address - Country:US
Mailing Address - Phone:323-466-8607
Mailing Address - Fax:323-466-2214
Practice Address - Street 1:321 N LARCHMONT BLVD STE 722
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-6407
Practice Address - Country:US
Practice Address - Phone:323-466-8607
Practice Address - Fax:323-466-2214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA411261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty