Provider Demographics
NPI:1194965582
Name:VALENTINA GOREN DDS, MICHAEL GOREN DDS, A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:VALENTINA GOREN DDS, MICHAEL GOREN DDS, A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:VALENTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOREN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-902-9999
Mailing Address - Street 1:14515 1/2 VICTORY BLVD
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91411-1619
Mailing Address - Country:US
Mailing Address - Phone:818-902-9999
Mailing Address - Fax:818-902-9393
Practice Address - Street 1:14515 1/2 VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91411-1619
Practice Address - Country:US
Practice Address - Phone:818-902-9999
Practice Address - Fax:818-902-9393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-25
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty