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General NPI Number Information
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NPI Number | 1477978823
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Entity Type | Organization
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Legal Business Name | N.BIMBLI, D.D.S, A PROFESSIONAL DENTAL CORPORATION
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Dates
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Enumeration Date | 02/21/2014
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Last Update Date | 02/21/2014
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Provider Practice Location Address
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Address Line | 13901 HAWTHORNE BLVD
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City | HAWTHORNE
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State | CA
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Zip | 90250-7001
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Country | US
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Telephone | 310-675-5050
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Fax | 310-675-5063
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Provider Business Mailing Address
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Address Line | 13901 HAWTHORNE BLVD
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City | HAWTHORNE
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State | CA
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Zip | 90250-7001
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Country | US
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Telephone | 310-675-5050
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Fax | 310-675-5063
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Authorized Official
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Title or Position | PRESIDENT/DENTIST
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Name | DR. NIKOLIN SPIRO BIMBLI
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Credential | D.D.S
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Telephone | 310-675-5050
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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 | 44147
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License Number State | CA
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