Provider Demographics
NPI:1477978823
Name:N.BIMBLI, D.D.S, A PROFESSIONAL DENTAL CORPORATION
Entity Type:Organization
Organization Name:N.BIMBLI, D.D.S, A PROFESSIONAL DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NIKOLIN
Authorized Official - Middle Name:SPIRO
Authorized Official - Last Name:BIMBLI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-675-5050
Mailing Address - Street 1:13901 HAWTHORNE BLVD
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-7001
Mailing Address - Country:US
Mailing Address - Phone:310-675-5050
Mailing Address - Fax:310-675-5063
Practice Address - Street 1:13901 HAWTHORNE BLVD
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-7001
Practice Address - Country:US
Practice Address - Phone:310-675-5050
Practice Address - Fax:310-675-5063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-21
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA441471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty