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General NPI Number Information
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NPI Number | 1346483914
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Entity Type | Organization
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Legal Business Name | EDALAT PAJOUH DENTAL CORP
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Dates
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Enumeration Date | 04/13/2009
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Last Update Date | 04/13/2009
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Provider Practice Location Address
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Address Line | 8704 W. PICO BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90035
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Country | US
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Telephone | 310-854-6565
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Fax | 310-854-0505
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Provider Business Mailing Address
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Address Line | 8704 W. PICO BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90035
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Country | US
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Telephone | 310-854-6565
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Fax | 310-854-0505
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Authorized Official
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Title or Position | PRESIDENT
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Name | FARAMARZ EDALAT PAJOUH
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Credential | D.M.D
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Telephone | 310-854-6565
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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 |
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License Number State | CA
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