Provider Demographics
NPI:1861560443
Name:GUSILATAR, RICHARD PENAMANTE (DDS)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:PENAMANTE
Last Name:GUSILATAR
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 1:20644 VENTURA BLVD
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-2314
Mailing Address - Country:US
Mailing Address - Phone:818-887-8900
Mailing Address - Fax:818-887-8976
Practice Address - Street 1:20644 VENTURA BLVD
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-2314
Practice Address - Country:US
Practice Address - Phone:818-887-8900
Practice Address - Fax:818-887-8976
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54561122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist