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General NPI Number Information
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NPI Number | 1720457500
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Entity Type | Organization
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Legal Business Name | NATALYA SHAGRAMANOVA DDS, INC
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Dates
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Enumeration Date | 09/22/2015
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Last Update Date | 09/25/2020
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Provider Practice Location Address
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Address Line | 1656 WILSHIRE BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90017-6011
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Country | US
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Telephone | 213-484-5050
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Fax | 213-484-5040
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Provider Business Mailing Address
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Address Line | 1656 WILSHIRE BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90017-1611
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Country | US
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Telephone | 213-484-5050
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Fax | 213-484-5040
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. NATALYA SHAGRAMANOVA DDS, INC
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Credential |
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Telephone | 818-653-7778
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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 | 54204
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License Number State | CA
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