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Organization
MERVAT S. BAKHOUM, D.D.S.
Active
Organization
MERVAT S. BAKHOUM, D.D.S.
Active
Parent organization
MERVAT S. BAKHOUM, D.D.S.
Organization subpart
Yes
Provider details
NPI number
Legal business name
MERVAT S. BAKHOUM, D.D.S.
Authorized official
MANEESH BANSAL (ADMINISTRATOR)
(323) 263-6103
Entity
Organization
Contact information
Practice address
443 S SOTO ST, SUITE 100, LOS ANGELES, CA 90033-4315
(323) 263-6103
Mailing address
5540 N FIGUEROA ST, LOS ANGELES, CA 90042-4120
(323) 478-1101
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
39940
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
G94072-01
—
CA
Enumeration date
02/27/2008
Last updated
02/27/2008
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