Provider Demographics
NPI:1972525855
Name:BEZIMYANSKY, NELLY (DDS)
Entity Type:Individual
Prefix:
First Name:NELLY
Middle Name:
Last Name:BEZIMYANSKY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 N CROFT AVE
Mailing Address - Street 2:#305
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90069-4287
Mailing Address - Country:US
Mailing Address - Phone:323-655-7007
Mailing Address - Fax:270-447-7337
Practice Address - Street 1:6360 WILSHIRE BLVD STE 510
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5601
Practice Address - Country:US
Practice Address - Phone:323-655-0855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50040122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist