Provider Demographics
NPI:1215038377
Name:ELBAZ, JEAN-JACQUES (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:JEAN-JACQUES
Middle Name:
Last Name:ELBAZ
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9465 WILSHIRE BLVD STE 450
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-2614
Mailing Address - Country:US
Mailing Address - Phone:310-274-0456
Mailing Address - Fax:310-274-0960
Practice Address - Street 1:9465 WILSHIRE BLVD STE 321
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-2602
Practice Address - Country:US
Practice Address - Phone:310-274-0456
Practice Address - Fax:310-274-0960
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA332801223P0106X, 1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodontics
No1223P0106XDental ProvidersDentistOral and Maxillofacial PathologyGroup - Multi-Specialty