Provider Demographics
NPI:1992195705
Name:ESRAILIAN, MELINA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MELINA
Middle Name:
Last Name:ESRAILIAN
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 1:847 N HOLLYWOOD WAY STE 102
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-2826
Mailing Address - Country:US
Mailing Address - Phone:818-841-5776
Mailing Address - Fax:
Practice Address - Street 1:847 N HOLLYWOOD WAY STE 102
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-2826
Practice Address - Country:US
Practice Address - Phone:818-841-5776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-01
Last Update Date:2015-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA527231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice