=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316425804
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | V. PAUL MESERKHANI DDS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/06/2018
-----------------------------------------------------
Last Update Date | 10/22/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2270 E COLORADO BLVD
-----------------------------------------------------
City | PASADENA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91107-3656
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-431-2930
-----------------------------------------------------
Fax | 626-431-2932
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2270 E COLORADO BLVD
-----------------------------------------------------
City | PASADENA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91107-3656
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-431-2930
-----------------------------------------------------
Fax | 626-431-2932
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF OPERATIONS
-----------------------------------------------------
Name | ALENOR CANLAS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 626-431-2930
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number | 39843
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QS0112X
-----------------------------------------------------
Taxonomy Name | Oral and Maxillofacial Surgery Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------