Provider Demographics
NPI:1386791895
Name:RAMSTRUM DENTAL PRACTICE
Entity type:Organization
Organization Name:RAMSTRUM DENTAL PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAGMAR
Authorized Official - Middle Name:JOHANNA
Authorized Official - Last Name:RAMSTRUM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:323-753-1411
Mailing Address - Street 1:643 W MANCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90044-5718
Mailing Address - Country:US
Mailing Address - Phone:323-753-1411
Mailing Address - Fax:323-753-3109
Practice Address - Street 1:643 W MANCHESTER AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90044-5718
Practice Address - Country:US
Practice Address - Phone:323-753-1411
Practice Address - Fax:323-753-3109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA231341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA23134OtherDENTI-CAL ID