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General NPI Number Information
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NPI Number | 1366852808
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Entity Type | Organization
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Legal Business Name | VLADIMIR KORBATOV,DDS, DENTAL CORP
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Dates
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Enumeration Date | 05/06/2014
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Last Update Date | 05/06/2014
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Provider Practice Location Address
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Address Line | 1019 N FAIRFAX AVE FL 2
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City | WEST HOLLYWOOD
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State | CA
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Zip | 90046-6160
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Country | US
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Telephone | 323-654-2607
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Fax | 323-654-0602
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Provider Business Mailing Address
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Address Line | 1019 N FAIRFAX AVE FL 2
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City | WEST HOLLYWOOD
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State | CA
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Zip | 90046-6160
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Country | US
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Telephone | 323-654-2607
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Fax | 323-654-0602
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Authorized Official
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Title or Position | GENERAL DENTIST/OWNER
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Name | DR. VLADIMIR Y KORBATOV
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Credential | D.D.S.
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Telephone | 323-654-2607
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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 | 25564
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License Number State | CA
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