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General NPI Number Information
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NPI Number | 1194266841
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Entity Type | Organization
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Legal Business Name | BEZAD DENTAL GROUP PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 03/14/2017
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Last Update Date | 03/14/2017
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Provider Practice Location Address
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Address Line | 5620 WILBUR AVE SUITE 310
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City | TARZANA
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State | CA
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Zip | 91356-1351
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Country | US
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Telephone | 323-886-3368
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Fax |
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Provider Business Mailing Address
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Address Line | 5620 WILBUR AVE SUITE 310
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City | TARZANA
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State | CA
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Zip | 91356-1351
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Country | US
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Telephone | 323-886-3368
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. PATRICIA BEZAD
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Credential | DMD
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Telephone | 323-886-3368
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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 | 54696
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License Number State | CA
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