Healthcare Provider Details

I. General information

NPI: 1861626483
Provider Name (Legal Business Name): VAHIK MESERKHANI DDS. INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2009
Last Update Date: 05/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 E. BROADWAY SUIT 102
GLENDALE CA
91205
US

IV. Provider business mailing address

520 E. BROADWAY SUIT 102
GLENDALE CA
91205
US

V. Phone/Fax

Practice location:
  • Phone: 818-242-4046
  • Fax: 818-244-6110
Mailing address:
  • Phone: 818-242-4046
  • Fax: 818-244-6110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number4398
License Number StateCA

VIII. Authorized Official

Name: MR. VAHIK PAUL MESERKHANI
Title or Position: OWNER
Credential: DDS AFAAIN
Phone: 818-242-4046