Healthcare Provider Details

I. General information

NPI: 1992625115
Provider Name (Legal Business Name): CALIFORNIA DENTAL INJURY GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5754 WILLOWCREST AVE
NORTH HOLLYWOOD CA
91601-2122
US

IV. Provider business mailing address

3900 W ALAMEDA AVE FL 15
BURBANK CA
91505-4316
US

V. Phone/Fax

Practice location:
  • Phone: --
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: ALIREZA MASHREGHI
Title or Position: DENTIST
Credential: DDS
Phone: 310-728-0130