Provider Demographics
NPI:1740811199
Name:DAVID ESRAELI DDS, PC
Entity type:Organization
Organization Name:DAVID ESRAELI DDS, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:ESRAELI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-825-9006
Mailing Address - Street 1:17651 VANOWEN ST STE A
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91406-4353
Mailing Address - Country:US
Mailing Address - Phone:818-600-8743
Mailing Address - Fax:
Practice Address - Street 1:17651 VANOWEN ST STE A
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91406-4353
Practice Address - Country:US
Practice Address - Phone:818-600-8743
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-03
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1417435926Medicaid