Provider Demographics
NPI:1841471752
Name:ADAMS, IRINA S (DMD)
Entity type:Individual
Prefix:
First Name:IRINA
Middle Name:S
Last Name:ADAMS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:IRINA
Other - Middle Name:S
Other - Last Name:KOPYOV
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:14256 VENTURA BLVD
Mailing Address - Street 2:STE 1
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423-2754
Mailing Address - Country:US
Mailing Address - Phone:818-385-1999
Mailing Address - Fax:818-385-1988
Practice Address - Street 1:14256 VENTURA BLVD
Practice Address - Street 2:STE 1
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91423-2754
Practice Address - Country:US
Practice Address - Phone:818-385-1999
Practice Address - Fax:818-385-1988
Is Sole Proprietor?:No
Enumeration Date:2007-11-19
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA563441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice