Healthcare Provider Details

I. General information

NPI: 1316426760
Provider Name (Legal Business Name): M JOURABCHI DENTAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2018
Last Update Date: 08/10/2021
Certification Date: 08/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14124 FOOTHILL BLVD STE 103
SYLMAR CA
91342-8052
US

IV. Provider business mailing address

14124 FOOTHILL BLVD STE 103
SYLMAR CA
91342-8052
US

V. Phone/Fax

Practice location:
  • Phone: 818-362-8333
  • Fax:
Mailing address:
  • Phone: 818-362-8333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number63660
License Number StateCA

VIII. Authorized Official

Name: DR. MICKEL JOURABCHI
Title or Position: CEO
Credential: DDS
Phone: 818-825-1618