Konviser Dental Professional Corporation

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

51095 Issued in CA

Legal business name

KONVISER DENTAL PROFESSIONAL CORPORATION

Practice address

4644 Lincoln Blvd Ste 404
Marina del Rey, CA 90292-6380

Phone

(310) 578-2500

NPI assigned

Aug 28, 2018

Organization subpart

No

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

Authorized official

Name

Vadim Konviser, DDS

Title

Ceo

Phone

(310) 578-2500

Specialties & licenses 1

Addresses

Other names 1

• OceanBreeze Dental Doing business as

Tax ID family

Konviser Dental Professional Corporation2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Konviser Dental Professional Corporation

  • Oral and Maxillofacial Surgery (Dentist)
  • Marina del Rey, CA
  • NPI 1265913081
  NPD tax ID

Locations

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

{
    "created_epoch": "1535414400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1535414400000",
    "number": "1831670637",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4644 LINCOLN BLVD STE 404",
            "city": "MARINA DEL REY",
            "state": "CA",
            "postal_code": "902926380",
            "telephone_number": "310-578-2500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4644 LINCOLN BLVD STE 404",
            "city": "MARINA DEL REY",
            "state": "CA",
            "postal_code": "902926380",
            "telephone_number": "310-578-2500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KONVISER DENTAL PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-28",
        "last_updated": "2018-08-28",
        "status": "A",
        "authorized_official_last_name": "KONVISER",
        "authorized_official_first_name": "VADIM",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "310-578-2500",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "CA",
            "license": "51095",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "OceanBreeze Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kobayashi Optometric Inc
• Susan Kohler, MSCCCSLP
• Mickey M Kolodny, MD
• Nataliia Komashko
• Konviser Dental Professional Corporation
• Myriam Liberty Koppelmann
• Jeremy E Korman, M.D.
• Priyanka Sharma Kosaraju
• Shaunna Kotka, OTD, OTR/L, CLT-LANA
• Kathryn Kreicher, MD

• Oral and Maxillofacial Surgery (Dentist) in Marina del Rey, CA
• Providers in Marina del Rey, CA by specialty
• Oral and Maxillofacial Surgery (Dentist) in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2018; 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.