Healthcare Provider Details

I. General information

NPI: 1316497126
Provider Name (Legal Business Name): VAHIK MESERKHANI DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2016
Last Update Date: 10/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 E BROADWAY
GLENDALE CA
91205-4926
US

IV. Provider business mailing address

520 E BROADWAY
GLENDALE CA
91205-4926
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number39843
License Number StateCA

VIII. Authorized Official

Name: VAHIK MESERKHANI
Title or Position: OWNER
Credential:
Phone: 818-242-4046