Healthcare Provider Details

I. General information

NPI: 1215038377
Provider Name (Legal Business Name): JEAN-JACQUES ELBAZ D.D.S., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 06/10/2021
Certification Date: 06/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9465 WILSHIRE BLVD STE 321
BEVERLY HILLS CA
90212-2602
US

IV. Provider business mailing address

9465 WILSHIRE BLVD STE 450
BEVERLY HILLS CA
90212-2614
US

V. Phone/Fax

Practice location:
  • Phone: 310-274-0456
  • Fax: 310-274-0960
Mailing address:
  • Phone: 310-274-0456
  • Fax: 310-274-0960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number33280
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number33280
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: