Provider Demographics
NPI:1346783214
Name:S ISSAC BINA DDS, A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:S ISSAC BINA DDS, A PROFESSIONAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAHIN
Authorized Official - Middle Name:ISSAC
Authorized Official - Last Name:BINA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-907-1818
Mailing Address - Street 1:16500 VENTURA BLVD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2011
Mailing Address - Country:US
Mailing Address - Phone:818-907-1818
Mailing Address - Fax:818-907-1819
Practice Address - Street 1:16500 VENTURA BLVD
Practice Address - Street 2:SUITE 150
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2011
Practice Address - Country:US
Practice Address - Phone:818-907-1818
Practice Address - Fax:818-907-1819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-28
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA458251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty