Provider Demographics
NPI:1871142505
Name:DR. HARRY H. ELYASSI, D.M.D., INC.
Entity type:Organization
Organization Name:DR. HARRY H. ELYASSI, D.M.D., INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:HARAPET
Authorized Official - Last Name:ELYASSI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:818-296-9660
Mailing Address - Street 1:221 E GLENOAKS BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91207-2165
Mailing Address - Country:US
Mailing Address - Phone:818-296-9660
Mailing Address - Fax:
Practice Address - Street 1:221 E GLENOAKS BLVD STE 210
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91207-2165
Practice Address - Country:US
Practice Address - Phone:818-926-8284
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-05
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA100246Medicaid