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General NPI Number Information
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NPI Number | 1306165964
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Entity Type | Organization
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Legal Business Name | PICASSOSMILES
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Dates
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Enumeration Date | 05/21/2010
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Last Update Date | 05/21/2010
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Provider Practice Location Address
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Address Line | 8863 ALCOTT ST APT 1
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City | LOS ANGELES
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State | CA
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Zip | 90035-3368
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Country | US
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Telephone | 310-663-6989
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Fax |
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Provider Business Mailing Address
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Address Line | 8863 ALCOTT ST APT 1
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City | LOS ANGELES
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State | CA
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Zip | 90035-3368
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Country | US
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Telephone | 310-663-6989
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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. NIMA E SHAYESTEH
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Credential | D.M.D.
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Telephone | 310-663-6989
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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 | 24979
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License Number State | TX
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