Provider Demographics
NPI:1881831196
Name:JIMMY SLAMAT, D.D.S., A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:JIMMY SLAMAT, D.D.S., A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:S
Authorized Official - Last Name:SLAMAT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:213-842-5489
Mailing Address - Street 1:600 W 9TH ST APT 216
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90015-4309
Mailing Address - Country:US
Mailing Address - Phone:213-842-5489
Mailing Address - Fax:213-622-0540
Practice Address - Street 1:607 W 6TH ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-3201
Practice Address - Country:US
Practice Address - Phone:213-624-6482
Practice Address - Fax:213-624-6483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-09
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA480231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty