Provider Demographics
NPI:1467667618
Name:UCLA PEDIATRIC DENTISTRY
Entity type:Organization
Organization Name:UCLA PEDIATRIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:LOPEZ
Authorized Official - Last Name:PIRAINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-825-8755
Mailing Address - Street 1:10833 LE CONTE AVE
Mailing Address - Street 2:20-137
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095-1668
Mailing Address - Country:US
Mailing Address - Phone:310-825-8755
Mailing Address - Fax:
Practice Address - Street 1:10833 LE CONTE AVE
Practice Address - Street 2:20-137
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-1668
Practice Address - Country:US
Practice Address - Phone:310-825-8755
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UCLA SCHOOL OF DENTISTRY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-11
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG91164-01OtherDENTICAL