Healthcare Provider Details

I. General information

NPI: 1366532012
Provider Name (Legal Business Name): MOSHREFI AND DANESHMAND, DDS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 08/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9735 WILSHIRE BLVD #211
BEVERLY HILLS CA
90212-2107
US

IV. Provider business mailing address

9735 WILSHIRE BLVD #211
BEVERLY HILLS CA
90212-2107
US

V. Phone/Fax

Practice location:
  • Phone: 310-859-9449
  • Fax: 310-859-9451
Mailing address:
  • Phone: 310-859-9449
  • Fax: 310-859-9451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number46300
License Number StateCA

VIII. Authorized Official

Name: DR. ABDOLLAH MOSHREFI
Title or Position: CEO
Credential: DDS, MS
Phone: 310-859-9449