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General NPI Number Information
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NPI Number | 1508281387
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Entity Type | Organization
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Legal Business Name | ANDRE ELIASIAN DENTAL CORPORATION
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Dates
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Enumeration Date | 03/03/2014
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Last Update Date | 03/03/2014
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Provider Practice Location Address
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Address Line | 1224 STANLEY AVE UNIT 10
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City | GLENDALE
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State | CA
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Zip | 91206-5629
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Country | US
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Telephone | 818-632-5005
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Fax |
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Provider Business Mailing Address
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Address Line | 290 E VERDUGO AVE 208
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City | BURBANK
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State | CA
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Zip | 91502-1300
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Country | US
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Telephone | 818-861-7427
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Fax | 818-861-7426
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. ANDRE ELIASIAN
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Credential | DDS
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Telephone | 818-632-5005
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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 | 62927
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License Number State | CA
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