Healthcare Provider Details

I. General information

NPI: 1407981939
Provider Name (Legal Business Name): PAUL ROBERT BILOVSKY DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4910 VAN NUYS BLVD SUITE 102
SHERMAN OAKS CA
91403-1715
US

IV. Provider business mailing address

4910 VAN NUYS BLVD SUITE 102
SHERMAN OAKS CA
91403-1715
US

V. Phone/Fax

Practice location:
  • Phone: 818-789-6622
  • Fax:
Mailing address:
  • Phone: 818-789-6622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDJ20319
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: