Provider Demographics
NPI:1619578341
Name:BEN ALYESH, D.D.S., INC.
Entity type:Organization
Organization Name:BEN ALYESH, D.D.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ALYESH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-826-9629
Mailing Address - Street 1:8628 VAN NUYS BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:PANORAMA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91402-2913
Mailing Address - Country:US
Mailing Address - Phone:818-895-1321
Mailing Address - Fax:818-892-3778
Practice Address - Street 1:8628 VAN NUYS BLVD STE 200
Practice Address - Street 2:
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402-2913
Practice Address - Country:US
Practice Address - Phone:818-895-1321
Practice Address - Fax:818-892-3778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-09
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA65169OtherDENTIST