Provider Demographics
NPI:1942717343
Name:BAKRAMIAN, JILBERT (DDS)
Entity Type:Individual
Prefix:DR
First Name:JILBERT
Middle Name:
Last Name:BAKRAMIAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:634 E MAPLE ST APT 4
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-4104
Mailing Address - Country:US
Mailing Address - Phone:818-378-1511
Mailing Address - Fax:
Practice Address - Street 1:19523 E CYPRESS ST
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91724-2066
Practice Address - Country:US
Practice Address - Phone:626-331-4538
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-07
Last Update Date:2018-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1022331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice