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General NPI Number Information
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NPI Number | 1376715771
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Entity Type | Organization
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Legal Business Name | DELDENTAL GROUP
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Dates
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Enumeration Date | 03/26/2008
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Last Update Date | 03/26/2008
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Provider Practice Location Address
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Address Line | 8035 W MANCHESTER AVE STE B
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City | PLAYA DEL REY
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State | CA
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Zip | 90293-7985
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Country | US
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Telephone | 310-822-8118
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Fax | 310-821-9276
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Provider Business Mailing Address
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Address Line | 8035 W MANCHESTER AVE STE B
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City | PLAYA DEL REY
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State | CA
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Zip | 90293-7985
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Country | US
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Telephone | 310-822-8118
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Fax | 310-821-9276
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Authorized Official
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Title or Position | OWNER
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Name | DR. SHAHRZAD Z FATTAHI
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Credential | DDS
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Telephone | 310-822-8118
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 41913
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License Number State | CA
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