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General NPI Number Information
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NPI Number | 1255400479
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Entity Type | Individual
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Provider Name | JACK BAYRAMYAN D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 11/06/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1201 N PACIFIC AVE STE 101
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City | GLENDALE
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State | CA
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Zip | 91202-3824
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Country | US
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Telephone | 818-244-5052
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Fax |
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Provider Business Mailing Address
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Address Line | 714 E ANGELENO AVE APT B
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City | BURBANK
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State | CA
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Zip | 91501-3005
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Country | US
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Telephone | 818-846-8899
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 51044
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License Number State | CA
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