Healthcare Provider Details

I. General information

NPI: 1083869382
Provider Name (Legal Business Name): REZA RADMAND D.M.D INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2008
Last Update Date: 12/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4070 STERLING WAY
BALDWIN PARK CA
91706-4223
US

IV. Provider business mailing address

4070 STERLING WAY
BALDWIN PARK CA
91706-4223
US

V. Phone/Fax

Practice location:
  • Phone: 626-480-7777
  • Fax:
Mailing address:
  • Phone: 626-480-7777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number38118
License Number StateCA

VIII. Authorized Official

Name: DR. REZA RADMAND
Title or Position: OWNER
Credential: DMD
Phone: 626-480-7777