Healthcare Provider Details

I. General information

NPI: 1639933948
Provider Name (Legal Business Name): B IRAVANI DDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2024
Last Update Date: 01/14/2026
Certification Date: 01/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2880 W OLYMPIC BLVD
LOS ANGELES CA
90006-2644
US

IV. Provider business mailing address

2880 W OLYMPIC BLVD
LOS ANGELES CA
90006-2644
US

V. Phone/Fax

Practice location:
  • Phone: 310-962-1119
  • Fax:
Mailing address:
  • Phone: 310-962-1119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. BOSHRA SOPHIA IRAVANI
Title or Position: DENTAL ANESTHESIOLOGIST
Credential: DDS
Phone: 240-751-3031