Provider Demographics
NPI:1801453121
Name:JEAN-JACQUES ELBAZ DDS MS A PROF DENTAL CORP
Entity type:Organization
Organization Name:JEAN-JACQUES ELBAZ DDS MS A PROF DENTAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RECEPTIONIST
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-274-0456
Mailing Address - Street 1:9465 WILSHIRE BLVD STE 450
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-2614
Mailing Address - Country:US
Mailing Address - Phone:310-274-0456
Mailing Address - Fax:
Practice Address - Street 1:9465 WILSHIRE BLVD STE 450
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-2614
Practice Address - Country:US
Practice Address - Phone:310-274-0456
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-22
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty