# LYLA BOUSTANI D.D.S. DENTAL CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Dental Specialty Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1538585294
- **Authorized official:** DR. LYLA BOUSTANI DDS (PRESIDENT)
- **Authorized official phone:** (818) 980-0998

## Contact information

- **Practice address:** 12626 RIVERSIDE DR, STE 403, STUDIO CITY, CA 91607-3420
- **Practice address phone:** (818) 980-0998
- **Practice address fax:** (818) 980-0991
- **Mailing address:** 12626 RIVERSIDE DR, STE 403, STUDIO CITY, CA 91607-3420
- **Mailing address phone:** (818) 980-0998
- **Mailing address fax:** (818) 980-0991

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223E0200X | Endodontics | — | — | Yes |
| 1223P0300X | Periodontics | — | — | — |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | — |

## Other

- **Enumeration date:** 03/05/2014
- **Last updated:** 03/05/2014