Provider Demographics
NPI:1376992586
Name:ELYASSI, HARRY HARAPET (DMD)
Entity Type:Individual
Prefix:DR
First Name:HARRY
Middle Name:HARAPET
Last Name:ELYASSI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 W BROADWAY STE 120
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-1023
Mailing Address - Country:US
Mailing Address - Phone:818-926-8284
Mailing Address - Fax:
Practice Address - Street 1:221 E GLENOAKS BLVD STE 210
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91207-2165
Practice Address - Country:US
Practice Address - Phone:818-296-9660
Practice Address - Fax:818-296-9075
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-08
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100246122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist