Healthcare Provider Details

I. General information

NPI: 1467271569
Provider Name (Legal Business Name): RF EDALATPAJOUH DENTAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2024
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36755 TIERRA SUBIDA AVE STE 140
PALMDALE CA
93551-7959
US

IV. Provider business mailing address

36755 TIERRA SUBIDA AVE STE 140
PALMDALE CA
93551-7959
US

V. Phone/Fax

Practice location:
  • Phone: 310-529-7292
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RYAN EDALATPAJOUH
Title or Position: VICE PRESIDENT
Credential:
Phone: 310-529-7292