Healthcare Provider Details

I. General information

NPI: 1225587876
Provider Name (Legal Business Name): SAM S MARKZAR DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2016
Last Update Date: 03/25/2024
Certification Date: 03/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8500 WILSHIRE BLVD STE 819
BEVERLY HILLS CA
90211-3106
US

IV. Provider business mailing address

8500 WILSHIRE BLVD STE 819
BEVERLY HILLS CA
90211-3106
US

V. Phone/Fax

Practice location:
  • Phone: 714-000-0000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number StateNULL

VIII. Authorized Official

Name: SAM S MARKZAR
Title or Position: SOLE OWNER
Credential:
Phone: 310-360-7570