Provider Demographics
NPI:1154515310
Name:JANET REFOA,D.D.S, INC.
Entity type:Organization
Organization Name:JANET REFOA,D.D.S, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:REFOA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-276-2009
Mailing Address - Street 1:8660 WILSHIRE BLVD.
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211
Mailing Address - Country:US
Mailing Address - Phone:310-276-2009
Mailing Address - Fax:310-273-0909
Practice Address - Street 1:8660 WILSHIRE BLVD
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-2910
Practice Address - Country:US
Practice Address - Phone:310-276-2009
Practice Address - Fax:310-273-0909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-30
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA269691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB269656-01Medicaid