Provider Demographics
NPI:1427253616
Name:BRYAN KEROPIAN, DDS A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:BRYAN KEROPIAN, DDS A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GLOVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-702-6002
Mailing Address - Street 1:22062 VENTURA BLVD
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-1645
Mailing Address - Country:US
Mailing Address - Phone:818-702-6002
Mailing Address - Fax:818-702-9053
Practice Address - Street 1:22062 VENTURA BLVD
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-1645
Practice Address - Country:US
Practice Address - Phone:818-702-6002
Practice Address - Fax:818-702-9053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19916122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6182360001Medicare NSC
CAW17187Medicare PIN