Healthcare Provider Details

I. General information

NPI: 1194653824
Provider Name (Legal Business Name): DR N SHAGRAMANOVA AND DR K SHAGRAMANOVA DENTAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3061 WABASH AVE
LOS ANGELES CA
90063-2765
US

IV. Provider business mailing address

3061 WABASH AVE
LOS ANGELES CA
90063-2765
US

V. Phone/Fax

Practice location:
  • Phone: 213-656-1033
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. NATALYA SHAGRAMANOVA
Title or Position: CEO/DENTIST
Credential: DDS
Phone: 818-653-7778