MEDICARE: AMOUR AND ELIA DENTAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	45810	CA
2	122300000X	Dentist	54459	CA

General Provider Information

NPI Number	:	1093267015
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMOUR AND ELIA DENTAL CORPORATION

Provider Business Mailing Address
First Line	:	13112 SHERMAN WAY
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91605-4645
Country	:	US
Telephone Number	:	818-982-6162
Fax Number	:	818-982-6214

Provider Business Practice Location Address
First Line	:	13112 SHERMAN WAY
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91605-4645
Country	:	US
Telephone Number	:	818-982-6162
Fax Number	:	818-982-6214

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. BACHAR ELIA
Credential	:	DDS
Telephone Number	:	818-982-6162

Provider Enumeration Date	:	10/25/2016
Last Update Date	:	10/25/2016

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Directions to “AMOUR AND ELIA DENTAL CORPORATION ” Practice Location

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