Healthcare Provider Details

I. General information

NPI: 1407953466
Provider Name (Legal Business Name): BITA SHAHANGIAN D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/30/2021
Certification Date: 04/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4821 LANKERSHIM BLVD STE B
NORTH HOLLYWOOD CA
91601-4572
US

IV. Provider business mailing address

4821 LANKERSHIM BLVD STE B
NORTH HOLLYWOOD CA
91601-4572
US

V. Phone/Fax

Practice location:
  • Phone: 818-508-7300
  • Fax: 818-301-2566
Mailing address:
  • Phone: 818-508-7300
  • Fax: 818-301-2566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number44082
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number44082
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: