Provider Demographics
NPI:1528369477
Name:PEZESHKI, BEATA (DDS)
Entity Type:Individual
Prefix:DR
First Name:BEATA
Middle Name:
Last Name:PEZESHKI
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 1:5363 BALBOA BLVD
Mailing Address - Street 2:#325
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-2805
Mailing Address - Country:US
Mailing Address - Phone:818-788-1181
Mailing Address - Fax:
Practice Address - Street 1:3467 ARDSLEY PL
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-4023
Practice Address - Country:US
Practice Address - Phone:818-429-2536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-09
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA599891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice