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Organization

ELI TABARAI, DMD DENTAL CORPORATION, A PROFESSIONAL DENTAL CORPORATION

Active
Organization subpart
No

Provider details

NPI number
Authorized official
ELI TABARIAI DMD (OWNER/ DOCTOR)
(310) 415-3521
Entity
Organization

Contact information

Practice address
11980 SAN VICENTE BLVD STE 802, LOS ANGELES, CA 90049-6606
(310) 415-3521
(323) 544-2994
Mailing address
PO BOX 24530, LOS ANGELES, CA 90024-0530
(310) 415-3521
(323) 544-2994

Taxonomy

Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1223S0112X
DENTIST- ORAL AND MAXILLOFACIAL SURGERY
CA
01
193400000X
SIGLE SPECIALTY GROUP
CA
Enumeration date
04/09/2010
Last updated
05/18/2022
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