Healthcare Provider Details

I. General information

NPI: 1639869993
Provider Name (Legal Business Name): SHAHINIAN AND NOVSHADIAN DENTAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2023
Last Update Date: 05/10/2023
Certification Date: 05/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3342 VERDUGO RD STE B
LOS ANGELES CA
90065-2845
US

IV. Provider business mailing address

3342 VERDUGO RD STE B
LOS ANGELES CA
90065-2845
US

V. Phone/Fax

Practice location:
  • Phone: 323-825-8558
  • Fax:
Mailing address:
  • Phone: 323-825-8558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. ANNA SHAHINIAN
Title or Position: OWNER DENTIST
Credential: DDS
Phone: 323-825-8558