Provider Demographics
NPI:1477602597
Name:FIRMAN, INGRID ELIANE (DDS)
Entity Type:Individual
Prefix:
First Name:INGRID
Middle Name:ELIANE
Last Name:FIRMAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 S VERMONT AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-1806
Mailing Address - Country:US
Mailing Address - Phone:213-387-4386
Mailing Address - Fax:213-387-4638
Practice Address - Street 1:309 S VERMONT AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90020-1806
Practice Address - Country:US
Practice Address - Phone:213-387-4386
Practice Address - Fax:213-387-4638
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26390122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA500791Medicaid