Provider Demographics
NPI:1154410710
Name:HOMYAK, NATALIA MARIA (DDS)
Entity type:Individual
Prefix:DR
First Name:NATALIA
Middle Name:MARIA
Last Name:HOMYAK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 BARBYDELL DRIVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-4808
Mailing Address - Country:US
Mailing Address - Phone:714-865-9407
Mailing Address - Fax:310-823-8600
Practice Address - Street 1:13160 MINDANAO WAY
Practice Address - Street 2:ROOM 170
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-6393
Practice Address - Country:US
Practice Address - Phone:310-823-6400
Practice Address - Fax:310-823-8600
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA495421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice