Provider Demographics
NPI:1396814588
Name:JACK BAYRAMYAN D.D.S., INC.
Entity Type:Organization
Organization Name:JACK BAYRAMYAN D.D.S., INC.
Other - Org Name:KIDS & FAMILY DENTAL PLACE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:BAYRAMYAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-335-2100
Mailing Address - Street 1:714 E ANGELENO AVE APT B
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91501-3005
Mailing Address - Country:US
Mailing Address - Phone:818-846-8899
Mailing Address - Fax:
Practice Address - Street 1:1201 N PACIFIC AVE STE 101
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91202-3824
Practice Address - Country:US
Practice Address - Phone:818-244-5052
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51044122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty