Provider Demographics
NPI:1124411384
Name:NELLY BEZIMYANSKY DDS, INC.
Entity Type:Organization
Organization Name:NELLY BEZIMYANSKY DDS, INC.
Other - Org Name:DREAM SMILES DENTAL ARTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:BEZIMYANSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-655-0865
Mailing Address - Street 1:6360 WILSHIRE BLVD STE 510
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-5601
Mailing Address - Country:US
Mailing Address - Phone:323-655-0865
Mailing Address - Fax:323-655-0868
Practice Address - Street 1:6360 WILSHIRE BLVD STE 510
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5601
Practice Address - Country:US
Practice Address - Phone:323-655-0865
Practice Address - Fax:323-655-0868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-12
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50040122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty