Provider Demographics
NPI:1881693448
Name:ASTRACHAN, DAVID JAY (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JAY
Last Name:ASTRACHAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5400 BALBOA BLVD
Mailing Address - Street 2:STE 230
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-1502
Mailing Address - Country:US
Mailing Address - Phone:818-788-3464
Mailing Address - Fax:818-783-3763
Practice Address - Street 1:5400 BALBOA BLVD
Practice Address - Street 2:STE 230
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-1502
Practice Address - Country:US
Practice Address - Phone:818-788-3464
Practice Address - Fax:818-783-3763
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19833122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist