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General NPI Number Information
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NPI Number | 1245512649
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Entity Type | Organization
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Legal Business Name | REZA M. BIRJANDI DDS., A PROFESSIONAL DENTAL CORPORATION
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Dates
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Enumeration Date | 09/13/2011
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Last Update Date | 10/15/2019
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Provider Practice Location Address
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Address Line | 28401 BRADLEY RD SUITE C
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City | SUN CITY
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State | CA
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Zip | 92586-3040
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Country | US
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Telephone | 951-679-0691
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Fax | 951-679-6094
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Provider Business Mailing Address
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Address Line | 28401 BRADLEY RD SUITE C
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City | SUN CITY
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State | CA
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Zip | 92586-3040
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Country | US
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Telephone | 951-679-0691
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Fax | 951-679-6094
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. ESBEIDY LOMELI
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Credential |
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Telephone | 951-679-0691
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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 | 38259
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License Number State | CA
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