Healthcare Provider Details

I. General information

NPI: 1104030741
Provider Name (Legal Business Name): DANESHMAND AND MOSHREFI, D.D.S., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 02/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3903 LONG BEACH BLVD
LONG BEACH CA
90807-2614
US

IV. Provider business mailing address

3903 LONG BEACH BLVD
LONG BEACH CA
90807-2614
US

V. Phone/Fax

Practice location:
  • Phone: 562-427-2478
  • Fax: 562-981-9258
Mailing address:
  • Phone: 562-427-2478
  • Fax: 562-981-9258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number45449
License Number StateCA

VIII. Authorized Official

Name: DR. NAZANIN DARESHMAND
Title or Position: OWNER
Credential: DDS
Phone: 562-427-2478