Healthcare Provider Details

I. General information

NPI: 1629326400
Provider Name (Legal Business Name): BEHNAM SALAR DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2012
Last Update Date: 10/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 S CURSON AVE APT 653
LOS ANGELES CA
90036-3666
US

IV. Provider business mailing address

600 S CURSON AVE APT 653
LOS ANGELES CA
90036-3666
US

V. Phone/Fax

Practice location:
  • Phone: 310-968-0562
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number61687
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: