Provider Demographics
NPI:1306982723
Name:ASWANI, POOJA (DDS)
Entity type:Individual
Prefix:
First Name:POOJA
Middle Name:
Last Name:ASWANI
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 1:2605 BASIL LN
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90077-2005
Mailing Address - Country:US
Mailing Address - Phone:310-869-5527
Mailing Address - Fax:323-822-1322
Practice Address - Street 1:2605 BASIL LN
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90077-2005
Practice Address - Country:US
Practice Address - Phone:310-869-5527
Practice Address - Fax:323-822-1322
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA492821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice