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General NPI Number Information
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NPI Number | 1316426760
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Entity Type | Organization
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Legal Business Name | M JOURABCHI DENTAL CORP
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Dates
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Enumeration Date | 08/07/2018
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Last Update Date | 08/10/2021
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Provider Practice Location Address
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Address Line | 14124 FOOTHILL BLVD STE 103
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City | SYLMAR
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State | CA
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Zip | 91342-8052
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Country | US
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Telephone | 818-362-8333
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Fax |
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Provider Business Mailing Address
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Address Line | 14124 FOOTHILL BLVD STE 103
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City | SYLMAR
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State | CA
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Zip | 91342-8052
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Country | US
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Telephone | 818-362-8333
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. MICKEL JOURABCHI
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Credential | DDS
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Telephone | 818-825-1618
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223D0001X
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Taxonomy Name | Public Health Dentistry
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License Number | 63660
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License Number State | CA
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