Healthcare Provider Details

I. General information

NPI: 1255400479
Provider Name (Legal Business Name): JACK BAYRAMYAN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 N PACIFIC AVE STE 101
GLENDALE CA
91202-3824
US

IV. Provider business mailing address

714 E ANGELENO AVE APT B
BURBANK CA
91501-3005
US

V. Phone/Fax

Practice location:
  • Phone: 818-244-5052
  • Fax:
Mailing address:
  • Phone: 818-846-8899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number51044
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: