Provider Demographics
NPI:1710164108
Name:NATALYA SHAGRAMANOVA D.D.S. INC.
Entity Type:Organization
Organization Name:NATALYA SHAGRAMANOVA D.D.S. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NATALYA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAGRAMANOVA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-653-7778
Mailing Address - Street 1:7924 WOODMAN AVE
Mailing Address - Street 2:#27
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91402-6246
Mailing Address - Country:US
Mailing Address - Phone:818-653-7778
Mailing Address - Fax:
Practice Address - Street 1:1150 N PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91202-2359
Practice Address - Country:US
Practice Address - Phone:818-240-0138
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-28
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54204122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty