Healthcare Provider Details

I. General information

NPI: 1063844942
Provider Name (Legal Business Name): MIKE PIRBAZARI, DDS, PHD. INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2013
Last Update Date: 08/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1807 WILSHIRE BLVD., SUITE A
SANTA MONICA CA
90403
US

IV. Provider business mailing address

269 S. BEVERLY DR., SUITE 436
BEVERLY HILLS CA
90212
US

V. Phone/Fax

Practice location:
  • Phone: 310-264-1711
  • Fax: 310-453-6486
Mailing address:
  • Phone: 310-339-3836
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number35447
License Number StateCA

VIII. Authorized Official

Name: MIKE PIRBAZARI
Title or Position: EMDODONTIST, OWNER
Credential: D.D.S, PH.D
Phone: 310-264-1711