Provider Demographics
NPI:1336216837
Name:ZOUEIN, GEORGETTE SPIRO (DDS)
Entity Type:Individual
Prefix:DR
First Name:GEORGETTE
Middle Name:SPIRO
Last Name:ZOUEIN
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 1:4400 S BROADWAY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90037-2791
Mailing Address - Country:US
Mailing Address - Phone:323-233-9400
Mailing Address - Fax:323-233-9977
Practice Address - Street 1:4400 S BROADWAY
Practice Address - Street 2:SUITE 103
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90037-2791
Practice Address - Country:US
Practice Address - Phone:323-233-9400
Practice Address - Fax:323-233-9977
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA439911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB43991Medicare ID - Type UnspecifiedDENTAL