Healthcare Provider Details

I. General information

NPI: 1306384789
Provider Name (Legal Business Name): BEVERLY HILLS SPECIALTY DENTAL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2017
Last Update Date: 02/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9301 WILSHIRE BLVD #407
BEVERLY HILLS CA
90210-5424
US

IV. Provider business mailing address

9301 WILSHIRE BLVD #407
BEVERLY HILLS CA
90210-5424
US

V. Phone/Fax

Practice location:
  • Phone: 310-278-3666
  • Fax: 310-278-6495
Mailing address:
  • Phone: 310-278-3666
  • Fax: 310-278-6495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number60046
License Number StateCA

VIII. Authorized Official

Name: DR. NICOLE BARKHORDAR
Title or Position: DDS M.ED
Credential: DDS, M.ED
Phone: 310-278-3666