Provider Demographics
NPI:1528535572
Name:LA ENDODONTICS, A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:LA ENDODONTICS, A PROFESSIONAL CORPORATION
Other - Org Name:GABREAL SHAMTOUB DDS INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GABREAL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAMTOUB
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:323-886-2414
Mailing Address - Street 1:5567 RESEDA BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-2648
Mailing Address - Country:US
Mailing Address - Phone:818-646-2923
Mailing Address - Fax:
Practice Address - Street 1:5567 RESEDA BLVD STE 100
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-2648
Practice Address - Country:US
Practice Address - Phone:818-646-2923
Practice Address - Fax:818-646-2924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-29
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty