Ucla Venice Dental Center
Clinic/Center, Dental in Venice, CA. Organization (NPI-2).
NPI number1255465902
StatusActive
Last updated in NPPESOct 2, 2025
Details
- NPI
- 1255465902
- Entity type
- Organization (NPI-2)
- Legal business name
- Ucla Venice Dental Center
- Organization subpart
- No
- Enumeration date
- Mar 15, 2007
- Certification date
- Oct 2, 2025
- Last updated
- Oct 2, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QD0000X | Clinic/Center, Dental | – | CA | Yes |
Other names
- Ucla School Of Dentistry (Other Name)
Practice location
323 Lincoln BlvdVenice, CA 90291-2842
Phone 310-392-4103
Mailing address
10833 Le Conte AveChs 33-019
Los Angeles, CA 90095-1668
Phone 310-825-4855
Authorized official
Marc Hayaseti
Associate Clinical Professor
3108254855
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