KONVISER DENTAL PROFESSIONAL CORPORATION (NPI# 1265913081) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1265913081 |
| Entity Type | Organization |
| Organization Name | KONVISER DENTAL PROFESSIONAL CORPORATION |
| Other Organization Name | OCEANBREEZE DENTAL |
| Practice Address |
4644 Lincoln Blvd Ste 404 Marina Del Rey CA 90292-6380 |
| Practice Telephone | 3105782500 |
| Mailing Telephone | 3105782500 |
| Enumeration Date | 2018-08-29 |
| Last Update Date | 2018-08-29 |
| Authorized Official Name | VADIM KONVISER (CEO) |
| Authorized Official Telephone | 3105782500 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 1223G0001X |
Dentist Specialization: General Practice |
51095 | CA | Dental Providers |
| Y | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
51095 | CA | Dental Providers |
| Other Name | Type Code |
|---|---|
| OceanBreeze Dental | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831670637 | Konviser Dental Professional Corporation | Dentist | 4644 Lincoln Blvd Ste 404, Marina Del Rey, CA 90292-6380 | 2018-08-28 |
| Street Address |
4644 LINCOLN BLVD STE 404 |
| City | MARINA DEL REY |
| State | CA |
| Zip Code | 90292-6380 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831670637 | Konviser Dental Professional Corporation | Dentist | 4644 Lincoln Blvd Ste 404, Marina Del Rey, CA 90292-6380 | 2018-08-28 |
| 1700367596 | Vadim Konviser Dds A Professional Corp | Dentist | 4644 Lincoln Blvd Ste 404, Marina Del Rey, CA 90292-6380 | 2018-08-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972142420 | Katy Kleinberg | Physical Therapist | 4820 Lincoln Blvd., Marina Del Rey, CA 90292 | 2020-01-02 |
| 1568028330 | Kylie Nakamine | Physical Therapist | 4820 Lincoln Bld, Marina Del Rey, CA 90292 | 2019-05-16 |
| 1033627807 | Kareema Nasouf | Social Worker | 578 Washington Blvd. #815, Marina Del Rey, CA 90292 | 2018-01-16 |
| 1861916611 | Jaqueline Berenice Higbee | Behavior Technician | 13428 Maxella Ave Apt 913, Marina Del Rey, CA 90292 | 2017-08-02 |
| 1063942696 | Luis Albert Japngie | Chiropractor | 13816 Bora Bora Way, A-109, Marina Del Rey, CA 90292 | 2017-06-15 |
| 1427509082 | Melissa Dowling | Nurse Anesthetist, Certified Registered | 4750 Lincoln Blvd Apt 477, Marina Del Rey, CA 90292 | 2016-10-19 |
| 1578932950 | Gratto Aquatic Rehab | Clinic/Center | 13160 Mindanao Way Ste. 308, Marina Del Ray, CA 90292 | 2015-09-16 |
| 1285018309 | Reed Chiropractic & Wellness Center A Professional Corporation | Chiropractor | 4207 Del Rey Ave., Marina Del Rey, CA 90292 | 2015-07-18 |
| 1083990725 | James J Kim | Pharmacist | 4009 Lincoln Blvd., Walgreens, Marina Del Rey, CA 90292 | 2011-10-26 |
| 1689957805 | Medbil, LLC | Anesthesiology | 1024 Oxford Ave., Marina Del Rey, CA 90292 | 2011-09-23 |
| Find all providers in zip 90292 | ||||
| Taxonomy Code | 1223S0112X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Oral and Maxillofacial Surgery |
| The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831670637 | Konviser Dental Professional Corporation | Dentist | 4644 Lincoln Blvd Ste 404, Marina Del Rey, CA 90292-6380 | 2018-08-28 |
| 1003952334 | Richard George Boudreau | Dentist | 13160 Mindanao Way, Suite 120, Marina Del Rey, CA 90292-6358 | 2007-01-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942807979 | Ayed Hawatmeh Dds Inc | Dentist | 322 E Foothill Blvd, Pomona, CA 91767 | 2020-10-02 |
| 1114533064 | Alexander V. Antipov, D.d.s., Inc. | Dentist | 911 Reserve Drive, Suite 150, Roseville, CA 95678 | 2020-09-16 |
| 1609493170 | Amir Haghshenas Dds | Dentist | 3880 S Bascom Ave Ste 213, San Jose, CA 95124-2675 | 2020-07-01 |
| 1316568900 | Beech & Reid Dental Partnership | Dentist | 464 E Calaveras Blvd Ste B3, Milpitas, CA 95035-5412 | 2020-05-05 |
| 1518506773 | Francisco Suarez, Dds Inc. | Dentist | 4606 Hollywood Blvd Ste A, Los Angeles, CA 90027-5462 | 2020-01-04 |
| 1831748839 | Slate Dental Corporation | Dentist | 6512 Lonetree Blvd Ste 100, Rocklin, CA 95765-5883 | 2019-09-11 |
| 1255980140 | Dr Maloux Macasaet Saguin Dental Corporation | Dentist | 9800 Topanga Canyon Blvd Ste J, Chatsworth, CA 91311-4075 | 2019-09-04 |
| 1891342267 | Amrollahie and Riman Dental Partnership | Dentist | 1442 Irvine Blvd Ste 225, Tustin, CA 92780-3846 | 2019-08-21 |
| 1548821572 | Hoang Dental Corporation | Dentist | 1356 W Valley Pkwy Ste J, Escondido, CA 92029-2138 | 2019-06-20 |
| 1073173860 | Omfs Care Center Partners | Dentist | 215 N Fresno St Ste 490, Fresno, CA 93701-0000 | 2019-06-14 |
| Find all providers with the same taxonomy | ||||
| City | MARINA DEL REY |
| Zip Code | 90292 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.