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General NPI Number Information
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NPI Number | 1447429303
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Entity Type | Organization
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Legal Business Name | MERVAT S. BAKHOUM, D.D.S.
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Dates
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Enumeration Date | 02/25/2008
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Last Update Date | 02/25/2008
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Provider Practice Location Address
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Address Line | 5540 N FIGUEROA ST
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City | LOS ANGELES
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State | CA
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Zip | 90042-4120
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Country | US
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Telephone | 323-478-1101
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Fax |
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Provider Business Mailing Address
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Address Line | 5540 N FIGUEROA ST
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City | LOS ANGELES
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State | CA
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Zip | 90042-4120
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Country | US
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Telephone | 323-478-1101
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MANEESH A. BANSAL
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Credential |
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Telephone | 323-478-1101
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 39940
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License Number State | CA
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