Provider Demographics
NPI:1972626026
Name:CYRUS B. CALLOS DDS INC.
Entity Type:Organization
Organization Name:CYRUS B. CALLOS DDS INC.
Other - Org Name:BRIGHTER SMILE DENTAL
Other - Org Type:Other Name
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CYRUS
Authorized Official - Middle Name:BAGSIK
Authorized Official - Last Name:CALLOS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-893-1782
Mailing Address - Street 1:9501 VAN NUYS BLVD
Mailing Address - Street 2:
Mailing Address - City:PANORAMA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91402-1350
Mailing Address - Country:US
Mailing Address - Phone:818-893-1782
Mailing Address - Fax:818-893-2778
Practice Address - Street 1:9501 VAN NUYS BLVD
Practice Address - Street 2:SUITE 115
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402-1350
Practice Address - Country:US
Practice Address - Phone:818-893-1782
Practice Address - Fax:818-893-2778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA492861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty