Healthcare Provider Details

I. General information

NPI: 1326860495
Provider Name (Legal Business Name): KHODADADI DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2024
Last Update Date: 10/29/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8500 WILSHIRE BLVD STE 527
BEVERLY HILLS CA
90211-3111
US

IV. Provider business mailing address

200 N SWALL DR UNIT 504
BEVERLY HILLS CA
90211-4725
US

V. Phone/Fax

Practice location:
  • Phone: 310-666-9024
  • Fax:
Mailing address:
  • Phone: 310-666-9024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VIII. Authorized Official

Name: SOHEIL KHODADADI
Title or Position: PRESIDENT
Credential: DDS
Phone: 310-717-5499