Healthcare Provider Details

I. General information

NPI: 1639718042
Provider Name (Legal Business Name): SEKIMOTO DENTAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2020
Last Update Date: 01/02/2020
Certification Date: 01/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4308 W MAGNOLIA BLVD
BURBANK CA
91505-2727
US

IV. Provider business mailing address

4308 W MAGNOLIA BLVD
BURBANK CA
91505-2727
US

V. Phone/Fax

Practice location:
  • Phone: 818-559-7600
  • Fax:
Mailing address:
  • Phone: 818-559-7600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. LENA BEDROSSIAN
Title or Position: DENTIST
Credential: DDS
Phone: 818-559-7600