# EDWIN BARZALLO, DDS, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1205000387
- **Authorized official:** DR. EDWIN O BARZALLO D.D.S. (OWNER)
- **Authorized official phone:** (323) 263-3300

## Contact information

- **Practice address:** 741 S ATLANTIC BLVD, LOS ANGELES, CA 90022-3213
- **Practice address phone:** (323) 263-3300
- **Practice address fax:** (323) 263-3400
- **Mailing address:** 741 S ATLANTIC BLVD, LOS ANGELES, CA 90022-3213
- **Mailing address phone:** (323) 263-3300
- **Mailing address fax:** (323) 263-3400

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 49467 | CA | Yes |

## Other

- **Enumeration date:** 04/18/2008
- **Last updated:** 04/18/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | G9240601 | — | CA |