Provider Demographics
NPI:1316426760
Name:M JOURABCHI DENTAL CORP
Entity type:Organization
Organization Name:M JOURABCHI DENTAL CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MICKEL
Authorized Official - Middle Name:
Authorized Official - Last Name:JOURABCHI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-825-1618
Mailing Address - Street 1:14124 FOOTHILL BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:SYLMAR
Mailing Address - State:CA
Mailing Address - Zip Code:91342-8052
Mailing Address - Country:US
Mailing Address - Phone:818-362-8333
Mailing Address - Fax:
Practice Address - Street 1:14124 FOOTHILL BLVD STE 103
Practice Address - Street 2:
Practice Address - City:SYLMAR
Practice Address - State:CA
Practice Address - Zip Code:91342-8052
Practice Address - Country:US
Practice Address - Phone:818-362-8333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-07
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA636601223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Multi-Specialty