Provider Demographics
NPI:1275313132
Name:OTHMAN SIJLAMASSI DMD PROFESSIONAL DENTAL CORP
Entity Type:Organization
Organization Name:OTHMAN SIJLAMASSI DMD PROFESSIONAL DENTAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:OTHMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SIJLAMASSI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:818-370-3778
Mailing Address - Street 1:6832 PONCE AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307-2610
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8363 RESEDA BLVD STE 10
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-4695
Practice Address - Country:US
Practice Address - Phone:818-370-3778
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-28
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty