Healthcare Provider Details

I. General information

NPI: 1447391016
Provider Name (Legal Business Name): PACIFIC DENTAL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9025 WILSHIRE BLVD STE 315
BEVERLY HILLS CA
90211-1831
US

IV. Provider business mailing address

9025 WILSHIRE BLVD STE 315
BEVERLY HILLS CA
90211-1831
US

V. Phone/Fax

Practice location:
  • Phone: 310-274-7485
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number45817
License Number StateCA

VIII. Authorized Official

Name: DR. FARSHAD MOFTAKHAR
Title or Position: ONWER
Credential:
Phone: 310-274-7485