Healthcare Provider Details

I. General information

NPI: 1841320041
Provider Name (Legal Business Name): BIAN T THE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 S ALVARADO ST
LOS ANGELES CA
90057-2238
US

IV. Provider business mailing address

1651 COUNTRY CLUB DR
GLENDALE CA
91208-2038
US

V. Phone/Fax

Practice location:
  • Phone: 213-484-9660
  • Fax:
Mailing address:
  • Phone: 818-241-7306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number23248
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: