Provider Demographics
NPI:1417255886
Name:ISRAEL, VICTOR MORRIS (DMD)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:MORRIS
Last Name:ISRAEL
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 1:209 S BEDFORD DR
Mailing Address - Street 2:209 SOUTH BEDFORD DR.
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-3722
Mailing Address - Country:US
Mailing Address - Phone:310-753-2638
Mailing Address - Fax:310-474-8533
Practice Address - Street 1:3737 MORAGA AVE STE B206
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-5492
Practice Address - Country:US
Practice Address - Phone:858-273-0700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-08
Last Update Date:2015-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59774122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist