Provider Demographics
NPI:1306408430
Name:E YAZICHIAN DENTAL CORP
Entity Type:Organization
Organization Name:E YAZICHIAN DENTAL CORP
Other - Org Name:SMILE ENCINO DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZA
Authorized Official - Middle Name:
Authorized Official - Last Name:YAZICHIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-990-9660
Mailing Address - Street 1:PO BOX 4223
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91503-4223
Mailing Address - Country:US
Mailing Address - Phone:213-800-5164
Mailing Address - Fax:
Practice Address - Street 1:16133 VENTURA BLVD STE 1070
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2440
Practice Address - Country:US
Practice Address - Phone:818-990-9660
Practice Address - Fax:818-990-9669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-28
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental