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General NPI Number Information
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NPI Number | 1932535366
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Entity Type | Individual
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Provider Name | AMY GABRIELA DIMITRAKOPOULOS D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 09/17/2013
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Last Update Date | 09/17/2013
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Provider Practice Location Address
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Address Line | 500 E OLIVE AVE SUITE 430
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City | BURBANK
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State | CA
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Zip | 91501-3316
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Country | US
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Telephone | 818-567-4662
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Fax |
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Provider Business Mailing Address
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Address Line | 395 SOUTHRIDGE DR
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City | OAK PARK
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State | CA
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Zip | 91377-3845
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 62598
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License Number State | CA
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