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General NPI Number Information
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NPI Number | 1306408430
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Entity Type | Organization
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Legal Business Name | E YAZICHIAN DENTAL CORP
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Dates
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Enumeration Date | 06/28/2019
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Last Update Date | 01/15/2021
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Provider Practice Location Address
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Address Line | 16133 VENTURA BLVD STE 1070
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City | ENCINO
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State | CA
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Zip | 91436-2440
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Country | US
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Telephone | 818-990-9660
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Fax | 818-990-9669
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Provider Business Mailing Address
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Address Line | PO BOX 4223
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City | BURBANK
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State | CA
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Zip | 91503-4223
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Country | US
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Telephone | 213-800-5164
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. ELIZA YAZICHIAN
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Credential | DDS
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Telephone | 818-990-9660
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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