Healthcare Provider Details

I. General information

NPI: 1689371932
Provider Name (Legal Business Name): ABEDI ALNATOUR & BAGHERI DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2023
Last Update Date: 02/07/2023
Certification Date: 02/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5175 E PACIFIC COAST HWY STE 405
LONG BEACH CA
90804-3313
US

IV. Provider business mailing address

9950 IRVINE CENTER DR
IRVINE CA
92618-4357
US

V. Phone/Fax

Practice location:
  • Phone: 562-597-8864
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. AHMAD ALNATOUR
Title or Position: VICE PRESIDENT
Credential: DDS
Phone: 310-570-8461