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General NPI Number Information
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NPI Number | 1124411384
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Entity Type | Organization
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Legal Business Name | NELLY BEZIMYANSKY DDS, INC.
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Dates
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Enumeration Date | 03/12/2015
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Last Update Date | 03/12/2015
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Provider Practice Location Address
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Address Line | 6360 WILSHIRE BLVD STE 510
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City | LOS ANGELES
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State | CA
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Zip | 90048-5601
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Country | US
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Telephone | 323-655-0865
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Fax | 323-655-0868
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Provider Business Mailing Address
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Address Line | 6360 WILSHIRE BLVD STE 510
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City | LOS ANGELES
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State | CA
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Zip | 90048-5601
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Country | US
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Telephone | 323-655-0865
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Fax | 323-655-0868
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Authorized Official
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Title or Position | OWNER
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Name | DR. NELLY BEZIMYANSKY
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Credential |
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Telephone | 323-655-0865
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 50040
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License Number State | CA
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