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General NPI Number Information
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NPI Number | 1144713173
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Entity Type | Individual
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Provider Name | MARAL RANJBAR AGHDAM
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Gender | Female
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Dates
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Enumeration Date | 06/13/2018
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Last Update Date | 06/14/2018
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Provider Practice Location Address
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Address Line | 1821 N LONG BEACH BLVD
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City | COMPTON
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State | CA
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Zip | 90221
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Country | US
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Telephone | 714-262-2708
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Fax |
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Provider Business Mailing Address
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Address Line | 3205-1151 WEST GEORGIA ST
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City | VANCOUVER
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State | BRITISH COLUMBIA
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Zip | V6E4E6
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Country | CA
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 102522
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License Number State | CA
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