Provider Demographics
NPI:1366852808
Name:VLADIMIR KORBATOV,DDS, DENTAL CORP
Entity Type:Organization
Organization Name:VLADIMIR KORBATOV,DDS, DENTAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VLADIMIR
Authorized Official - Middle Name:Y
Authorized Official - Last Name:KORBATOV
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:323-654-2607
Mailing Address - Street 1:1019 N FAIRFAX AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90046-6160
Mailing Address - Country:US
Mailing Address - Phone:323-654-2607
Mailing Address - Fax:323-654-0602
Practice Address - Street 1:1019 N FAIRFAX AVE FL 2
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90046-6160
Practice Address - Country:US
Practice Address - Phone:323-654-2607
Practice Address - Fax:323-654-0602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-06
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25564122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty