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General NPI Number Information
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NPI Number | 1801453121
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Entity Type | Organization
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Legal Business Name | JEAN-JACQUES ELBAZ DDS MS A PROF DENTAL CORP
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Dates
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Enumeration Date | 05/22/2019
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Last Update Date | 08/02/2021
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Provider Practice Location Address
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Address Line | 9465 WILSHIRE BLVD STE 450
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City | BEVERLY HILLS
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State | CA
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Zip | 90212-2614
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Country | US
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Telephone | 310-274-0456
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Fax |
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Provider Business Mailing Address
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Address Line | 9465 WILSHIRE BLVD STE 450
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City | BEVERLY HILLS
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State | CA
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Zip | 90212-2614
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Country | US
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Telephone | 310-274-0456
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Fax |
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Authorized Official
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Title or Position | RECEPTIONIST
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Name | MARIA RIVAS
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Credential |
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Telephone | 310-274-0456
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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