Provider Demographics
NPI:1447253992
Name:YAZICHIAN, ELIZA (DDS)
Entity type:Individual
Prefix:DR
First Name:ELIZA
Middle Name:
Last Name:YAZICHIAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4223
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91503-4223
Mailing Address - Country:US
Mailing Address - Phone:818-848-0078
Mailing Address - Fax:818-840-0010
Practice Address - Street 1:921 W OLIVE AVE
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91506-2209
Practice Address - Country:US
Practice Address - Phone:818-848-0078
Practice Address - Fax:818-840-0010
Is Sole Proprietor?:No
Enumeration Date:2005-05-28
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA504051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD50405OtherMEDICAL