=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427253616
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BRYAN KEROPIAN, DDS A PROFESSIONAL CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/18/2007
-----------------------------------------------------
Last Update Date | 04/23/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 22062 VENTURA BLVD
-----------------------------------------------------
City | WOODLAND HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91364-1645
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-702-6002
-----------------------------------------------------
Fax | 818-702-9053
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 22062 VENTURA BLVD
-----------------------------------------------------
City | WOODLAND HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91364-1645
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-702-6002
-----------------------------------------------------
Fax | 818-702-9053
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | MRS. DEBBIE GLOVER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 818-702-6002
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 19916
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------