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General NPI Number Information
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NPI Number | 1295924959
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Entity Type | Organization
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Legal Business Name | GHOLAM-REZA ZARRINNEGAR DDS INC
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Dates
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Enumeration Date | 10/18/2007
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Last Update Date | 10/18/2007
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Provider Practice Location Address
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Address Line | 19231 VICTORY BLVD SUITE 37
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City | RESEDA
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State | CA
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Zip | 91335-6308
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Country | US
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Telephone | 818-344-0177
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Fax |
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Provider Business Mailing Address
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Address Line | 19231 VICTORY BLVD SUITE 37
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City | RESEDA
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State | CA
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Zip | 91335-6308
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Country | US
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Telephone |
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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. GHOLAM-REZA ZARRINNEGAR
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Credential | DDS
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Telephone | 818-344-0177
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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 | 56090
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 53492
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License Number State | CA
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