Healthcare Provider Details

I. General information

NPI: 1326486705
Provider Name (Legal Business Name): LEILA ZAMIRI DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2013
Last Update Date: 04/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5828 CHERRY AVE
LONG BEACH CA
90805-4406
US

IV. Provider business mailing address

3317 E 10TH ST 3317 E. 10TH ST.
LONG BEACH CA
90804-5050
US

V. Phone/Fax

Practice location:
  • Phone: 562-422-6838
  • Fax: 562-422-6867
Mailing address:
  • Phone: 562-438-2500
  • Fax: 562-438-2555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: LEILA ZAMIRI
Title or Position: OWNER
Credential: DDS
Phone: 562-438-2500