Provider Demographics
NPI:1144389065
Name:ELIA, BACHAR (DDS)
Entity Type:Individual
Prefix:DR
First Name:BACHAR
Middle Name:
Last Name:ELIA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9837 TUJUNGA CANYON PL
Mailing Address - Street 2:
Mailing Address - City:TUJUNGA
Mailing Address - State:CA
Mailing Address - Zip Code:91042-2910
Mailing Address - Country:US
Mailing Address - Phone:818-352-4524
Mailing Address - Fax:
Practice Address - Street 1:1101 TRUMAN ST
Practice Address - Street 2:SUITE A
Practice Address - City:SAN FERNANDO
Practice Address - State:CA
Practice Address - Zip Code:91340-3237
Practice Address - Country:US
Practice Address - Phone:818-898-1434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54459122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist