Provider Demographics
NPI:1245665124
Name:BOCHORISHVILI, GEORGE (DDS)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:BOCHORISHVILI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:GEORGE
Other - Middle Name:
Other - Last Name:BOVILI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:435 N BEDFORD DR
Mailing Address - Street 2:SUITE #306
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4321
Mailing Address - Country:US
Mailing Address - Phone:310-275-1137
Mailing Address - Fax:310-274-9876
Practice Address - Street 1:435 N BEDFORD DR
Practice Address - Street 2:SUITE #306
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4321
Practice Address - Country:US
Practice Address - Phone:310-275-1137
Practice Address - Fax:310-274-9876
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-10
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62536122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist