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General NPI Number Information
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NPI Number | 1235563396
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Entity Type | Organization
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Legal Business Name | DR ROLAND YAKUBOV DDS DENTAL CORPORATION
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Dates
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Enumeration Date | 08/26/2013
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Last Update Date | 05/23/2022
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Provider Practice Location Address
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Address Line | 6428 BELLINGHAM AVE
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City | NORTH HOLLYWOOD
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State | CA
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Zip | 91606-1402
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Country | US
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Telephone | 818-726-8534
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Fax |
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Provider Business Mailing Address
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Address Line | 6430 BELLINGHAM AVE
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City | NORTH HOLLYWOOD
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State | CA
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Zip | 91606-1402
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Country | US
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Telephone | 818-985-1148
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Fax | 818-985-1402
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROLAND YAKUBOV
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Credential | DMD
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Telephone | 818-726-8534
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 57065
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License Number State | CA
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