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General NPI Number Information
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NPI Number | 1326860495
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Entity Type | Organization
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Legal Business Name | KHODADADI DENTAL CORPORATION
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Dates
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Enumeration Date | 10/29/2024
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Last Update Date | 10/29/2024
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Provider Practice Location Address
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Address Line | 8500 WILSHIRE BLVD STE 527
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City | BEVERLY HILLS
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State | CA
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Zip | 90211-3111
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Country | US
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Telephone | 310-666-9024
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Fax |
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Provider Business Mailing Address
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Address Line | 200 N SWALL DR UNIT 504
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City | BEVERLY HILLS
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State | CA
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Zip | 90211-4725
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Country | US
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Telephone | 310-666-9024
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | SOHEIL KHODADADI
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Credential | DDS
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Telephone | 310-717-5499
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number |
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License Number State |
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