Provider Demographics
NPI:1134494743
Name:TALASAZAN, ANNALISA (DMD)
Entity Type:Individual
Prefix:
First Name:ANNALISA
Middle Name:
Last Name:TALASAZAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:936 N LA CIENEGA BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90069-4710
Mailing Address - Country:US
Mailing Address - Phone:310-801-6448
Mailing Address - Fax:
Practice Address - Street 1:936 N LA CIENEGA BLVD
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90069-4710
Practice Address - Country:US
Practice Address - Phone:310-801-6448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-14
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA606931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice