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General NPI Number Information
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NPI Number | 1063690386
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Entity Type | Organization
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Legal Business Name | GAREMANI SHAHMOHAMMADI DDS PROFESSIONAL DENTAL CORP
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Dates
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Enumeration Date | 02/08/2008
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Last Update Date | 02/08/2008
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Provider Practice Location Address
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Address Line | 8540 RESEDA BLVD #102
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City | NORTHRIDGE
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State | CA
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Zip | 91324
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Country | US
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Telephone | 818-280-0385
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Fax | 818-701-0418
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Provider Business Mailing Address
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Address Line | 8540 RESEDA BLVD #102
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City | NORTHRIDGE
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State | CA
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Zip | 91324
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Country | US
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Telephone | 818-280-0385
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Fax | 818-701-0418
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Authorized Official
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Title or Position | PRESIDENT ORTHODONTICS
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Name | MRS. REZA M GAREMANI
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Credential | DDS BOARD CERTIFIED
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Telephone | 818-280-0385
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 34492
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License Number State | CA
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