Provider Demographics
NPI:1528849759
Name:JACK A. BAYRAMYAN DDS INC
Entity type:Organization
Organization Name:JACK A. BAYRAMYAN DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:A
Authorized Official - Last Name:BAYRAMYAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-629-4004
Mailing Address - Street 1:5744 SAN FERNANDO RD STE 202
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91202-2181
Mailing Address - Country:US
Mailing Address - Phone:702-900-5005
Mailing Address - Fax:
Practice Address - Street 1:18607 VENTURA BLVD STE 209
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-4171
Practice Address - Country:US
Practice Address - Phone:818-578-8665
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-12
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty