Provider Demographics
NPI:1598166464
Name:GEORGETTE ZOUEIN DENTAL CORP
Entity Type:Organization
Organization Name:GEORGETTE ZOUEIN DENTAL CORP
Other - Org Name:GEORGETTE ZOUEIN DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGETTE
Authorized Official - Middle Name:KHOURY
Authorized Official - Last Name:ZOUEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:323-233-9400
Mailing Address - Street 1:4400 S BROADWAY STE 103
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90037-2792
Mailing Address - Country:US
Mailing Address - Phone:323-233-9400
Mailing Address - Fax:323-233-9977
Practice Address - Street 1:4400 S BROADWAY STE 103
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90037-2792
Practice Address - Country:US
Practice Address - Phone:323-233-9400
Practice Address - Fax:323-233-9977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-10
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA439911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty