Provider Demographics
NPI:1427838911
Name:CELLARS DENTAL CORPORATION
Entity type:Organization
Organization Name:CELLARS DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:FARRINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:831-747-0636
Mailing Address - Street 1:5114 VENICE BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90019-5229
Mailing Address - Country:US
Mailing Address - Phone:831-747-0636
Mailing Address - Fax:
Practice Address - Street 1:5114 VENICE BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90019-5229
Practice Address - Country:US
Practice Address - Phone:831-747-0636
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental