Provider Demographics
NPI:1922513225
Name:MICHEL ELYSON DDS & RAMIN ASSILI DDS,A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:MICHEL ELYSON DDS & RAMIN ASSILI DDS,A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHEL
Authorized Official - Middle Name:H
Authorized Official - Last Name:ELYSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-263-2125
Mailing Address - Street 1:9535 RESEDA BLVD STE 203
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-6027
Mailing Address - Country:US
Mailing Address - Phone:818-349-6373
Mailing Address - Fax:818-349-7539
Practice Address - Street 1:9535 RESEDA BLVD STE 203
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-6027
Practice Address - Country:US
Practice Address - Phone:818-349-6379
Practice Address - Fax:818-349-7539
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MICHEL H. ELYSON DDS & RAMIN ASSILI DDS APC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-12-08
Last Update Date:2017-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40605122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1235272287Medicaid
CA1427187996Medicaid