Healthcare Provider Details

I. General information

NPI: 1639920671
Provider Name (Legal Business Name): DADJOO AND COX DENTAL CORPORATION PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2024
Last Update Date: 08/27/2024
Certification Date: 08/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19950 RINALDI ST STE 306
PORTER RANCH CA
91326-4254
US

IV. Provider business mailing address

19950 RINALDI ST STE 306
PORTER RANCH CA
91326-4254
US

V. Phone/Fax

Practice location:
  • Phone: 818-831-7600
  • Fax:
Mailing address:
  • Phone: 818-831-7600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: SHAAHIN DADJOO
Title or Position: OWNER
Credential:
Phone: 818-831-7600