Provider Demographics
NPI:1184980443
Name:MULABECIROVIC, AMNERIS (DDS)
Entity type:Individual
Prefix:
First Name:AMNERIS
Middle Name:
Last Name:MULABECIROVIC
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 1:1127 WILSHIRE BL #1116
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017
Mailing Address - Country:US
Mailing Address - Phone:213-250-7821
Mailing Address - Fax:213-250-7738
Practice Address - Street 1:1127 WILSHIRE BL #1116
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017
Practice Address - Country:US
Practice Address - Phone:213-250-7821
Practice Address - Fax:213-250-7738
Is Sole Proprietor?:No
Enumeration Date:2012-04-11
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA432071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice