Provider Demographics
NPI:1184882391
Name:KRASNODARA GASHPAROVA, DDS, INC
Entity type:Organization
Organization Name:KRASNODARA GASHPAROVA, DDS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KRASNODARA
Authorized Official - Middle Name:N
Authorized Official - Last Name:GASHPAROVA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-572-6375
Mailing Address - Street 1:1933 W VALLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91803-2346
Mailing Address - Country:US
Mailing Address - Phone:626-289-6131
Mailing Address - Fax:626-289-0408
Practice Address - Street 1:1933 W VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91803-2346
Practice Address - Country:US
Practice Address - Phone:626-289-6131
Practice Address - Fax:626-289-0408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-26
Last Update Date:2008-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53452261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1223G0001XOtherTAXONOMY
CA1235317033OtherNPI TYPE 1