Healthcare Provider Details

I. General information

NPI: 1083912430
Provider Name (Legal Business Name): COHEN SEDGH, MANAVI& PAKRAVAN DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2011
Last Update Date: 06/27/2022
Certification Date: 06/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28237 NEWHALL RANCH RD
VALENCIA CA
91355-0986
US

IV. Provider business mailing address

28237 NEWHALL RANCH RD
VALENCIA CA
91355-0986
US

V. Phone/Fax

Practice location:
  • Phone: 661-257-4242
  • Fax: 661-294-0020
Mailing address:
  • Phone: 661-257-4242
  • Fax: 661-294-0020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number38558
License Number StateCA

VIII. Authorized Official

Name: FARHAD MANAVI
Title or Position: OWNER
Credential:
Phone: 310-820-9933