Healthcare Provider Details

I. General information

NPI: 1639087067
Provider Name (Legal Business Name): E AND M DENTAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3058 E GAGE AVE
HUNTINGTON PARK CA
90255-4432
US

IV. Provider business mailing address

6200 WILSHIRE BLVD STE 1609
LOS ANGELES CA
90048-5817
US

V. Phone/Fax

Practice location:
  • Phone: 323-581-2603
  • Fax:
Mailing address:
  • Phone: 323-336-8478
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: IGAL ELYASSI
Title or Position: OWNER
Credential: DDS
Phone: 323-336-8478