Provider Demographics
NPI:1801936430
Name:MOTTOLA, PHILIP MICHAEL (DDS)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:MICHAEL
Last Name:MOTTOLA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18399 VENTURA BLVD STE 234
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-6409
Mailing Address - Country:US
Mailing Address - Phone:818-708-3232
Mailing Address - Fax:818-996-6049
Practice Address - Street 1:18399 VENTURA BLVD STE 234
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-6409
Practice Address - Country:US
Practice Address - Phone:818-708-3232
Practice Address - Fax:818-996-6049
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA195631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice