Provider Demographics
NPI:1437310646
Name:TABARIAI, ELI (DMD)
Entity Type:Individual
Prefix:DR
First Name:ELI
Middle Name:
Last Name:TABARIAI
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:PO BOX 24530
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-0530
Mailing Address - Country:US
Mailing Address - Phone:310-415-3521
Mailing Address - Fax:323-544-2994
Practice Address - Street 1:11980 SAN VICENTE BLVD STE 802
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049-6606
Practice Address - Country:US
Practice Address - Phone:310-415-3521
Practice Address - Fax:323-544-2994
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-19
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56696204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery