| Hollywood Braces | |
|
12626 Riverside Dr. #408 Valley Village CA 91607-3453 | |
| (323) 656-9111 | |
| Not Available |
| Full Name | Hollywood Braces |
|---|---|
| Speciality | Dentist - Orthodontics And Dentofacial Orthopedics |
| Location | 12626 Riverside Dr., Valley Village, California |
| Authorized Official Name and Position | Yury B. Geylikman (CEO) |
| Authorized Official Contact | 3236569111 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Hollywood Braces 12626 Riverside Dr. #408 Valley Village CA 91607-3453 Ph: (323) 656-9111 | Hollywood Braces 12626 Riverside Dr. #408 Valley Village CA 91607-3453 Ph: (323) 656-9111 |
| NPI Number | 1417070806 |
|---|---|
| Provider Enumeration Date | 04/09/2007 |
| Last Update Date | 02/09/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417070806 | NPI | - | NPPES |
| B41255 | Other | CA | MEDI-CAL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 41255 (California) | Secondary |
| 1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | 41255 (California) | Primary |
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