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General NPI Number Information
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NPI Number | 1265721138
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Entity Type | Organization
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Legal Business Name | BEVERLY DENTAL DRIVE CARE
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Dates
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Enumeration Date | 03/31/2011
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Last Update Date | 03/31/2011
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Provider Practice Location Address
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Address Line | 1125 S BEVERLY DR STE # 750B
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City | LOS ANGELES
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State | CA
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Zip | 90035-1148
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Country | US
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Telephone | 310-277-7645
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Fax |
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Provider Business Mailing Address
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Address Line | 1125 S BEVERLY DR STE 750B
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City | LOS ANGELES
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State | CA
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Zip | 90035-1130
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Country | US
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Telephone | 310-277-7645
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BABAK BOBBY IRANI
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Credential | DDS
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Telephone | 310-277-7645
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 48466
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License Number State | CA
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