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General NPI Number Information
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NPI Number | 1245784305
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Entity Type | Organization
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Legal Business Name | MANHATTAN BEACH DENTAL ESTHETICS
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Dates
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Enumeration Date | 08/06/2016
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Last Update Date | 08/06/2016
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Provider Practice Location Address
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Address Line | 200 N AVIATION BLVD UNIT A
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City | MANHATTAN BEACH
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State | CA
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Zip | 90266-7015
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Country | US
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Telephone | 310-937-6453
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Fax |
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Provider Business Mailing Address
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Address Line | 200 N AVIATION BLVD UNIT A
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City | MANHATTAN BEACH
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State | CALIFORNIA
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Zip | 90266
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Country | UM
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Telephone | 310-937-6453
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ARASH R. PANAH
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Credential |
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Telephone | 310-937-6453
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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 | 48000
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License Number State | CA
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