Provider Demographics
NPI:1922642057
Name:BAKHSHALIAN DENTAL CORPORATION
Entity Type:Organization
Organization Name:BAKHSHALIAN DENTAL CORPORATION
Other - Org Name:BAK IMPLANT STUDIO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NEEMA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS, PHD
Authorized Official - Phone:213-362-8076
Mailing Address - Street 1:18740 VENTURA BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-6301
Mailing Address - Country:US
Mailing Address - Phone:818-705-3232
Mailing Address - Fax:
Practice Address - Street 1:18740 VENTURA BLVD STE 103
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-6301
Practice Address - Country:US
Practice Address - Phone:818-705-3232
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-01
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty