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General NPI Number Information
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NPI Number | 1184179129
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Entity Type | Organization
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Legal Business Name | PACIFIC ORTHODONTICS, LLC
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Dates
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Enumeration Date | 08/19/2016
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Last Update Date | 08/19/2016
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Provider Practice Location Address
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Address Line | 2021 SANTA MONICA BLVD SUITE 340E
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City | SANTA MONICA
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State | CA
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Zip | 90404-2208
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Country | US
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Telephone | 310-846-8676
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Fax |
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Provider Business Mailing Address
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Address Line | 11150 SANTA MONICA BLVD SUITE 1400
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City | LOS ANGELES
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State | CA
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Zip | 90025-3380
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Country | US
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Telephone | 310-846-8676
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Fax |
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Authorized Official
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Title or Position | DR
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Name | MAURICE FIROUZ
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Credential | DDS
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Telephone | 310-447-5790
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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 |
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License Number State |
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