Provider Demographics
NPI:1477897494
Name:LEBOVITZ, TALIA (DDS)
Entity Type:Individual
Prefix:DR
First Name:TALIA
Middle Name:
Last Name:LEBOVITZ
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 1:2262 S BEVERLY DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-1006
Mailing Address - Country:US
Mailing Address - Phone:347-387-7181
Mailing Address - Fax:
Practice Address - Street 1:3932 WILSHIRE BLVD STE 306
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-3307
Practice Address - Country:US
Practice Address - Phone:347-387-7181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-15
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA620441223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics