MEDICARE: DADJOO AND COX DENTAL CORPORATION PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332BC3200X	Customized Equipment (DME)
2	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1639920671
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DADJOO AND COX DENTAL CORPORATION PC

Provider Business Mailing Address
First Line	:	19950 RINALDI ST STE 306
Second Line	:
City	:	PORTER RANCH
State	:	CA
Zip	:	91326-4254
Country	:	US
Telephone Number	:	818-831-7600
Fax Number	:

Provider Business Practice Location Address
First Line	:	19950 RINALDI ST STE 306
Second Line	:
City	:	PORTER RANCH
State	:	CA
Zip	:	91326-4254
Country	:	US
Telephone Number	:	818-831-7600
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SHAAHIN DADJOO
Credential	:
Telephone Number	:	818-831-7600

Provider Enumeration Date	:	03/28/2024
Last Update Date	:	08/27/2024

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