Provider Demographics
NPI:1023268513
Name:YAKUBOV, ROLAND (DMD)
Entity type:Individual
Prefix:DR
First Name:ROLAND
Middle Name:
Last Name:YAKUBOV
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:827 N HOLLYWOOD WAY APT 448
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-2814
Mailing Address - Country:US
Mailing Address - Phone:818-985-1148
Mailing Address - Fax:
Practice Address - Street 1:6428 BELLINGHAM AVE
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606-1402
Practice Address - Country:US
Practice Address - Phone:818-985-1407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-22
Last Update Date:2019-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA570641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice