Anatoly Vaisan DDS Inc

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

88476-48 Issued in CA

Legal business name

ANATOLY VAISAN DDS INC

Practice address

11273 Laurel Canyon Blvd
Suite#3
San Fernando, CA 91340-4300

Phone

(818) 365-7191

Fax

(818) 361-7641

NPI assigned

Jan 8, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Anatoly Vaisman, DDS

Title

Owner/Dentist

Phone

(818) 365-7191

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168214400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1508716800000",
    "number": "1023166600",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11273 LAUREL CANYON BLVD",
            "address_2": "SUITE#3",
            "city": "SAN FERNANDO",
            "state": "CA",
            "postal_code": "913404300",
            "telephone_number": "818-365-7191",
            "fax_number": "818-361-7641"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11273 LAUREL CANYON BLVD",
            "address_2": "SUITE#3",
            "city": "SAN FERNANDO",
            "state": "CA",
            "postal_code": "913404300",
            "telephone_number": "818-365-7191",
            "fax_number": "818-361-7641"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANATOLY VAISAN DDS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-08",
        "last_updated": "2017-10-23",
        "status": "A",
        "authorized_official_last_name": "VAISMAN",
        "authorized_official_first_name": "ANATOLY",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "818-365-7191",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "CA",
            "license": "88476-48",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dental Clinic/Center in San Fernando, CA
• Providers in San Fernando, CA by specialty
• Dental Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.