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General NPI Number Information
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NPI Number | 1396285342
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Entity Type | Organization
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Legal Business Name | RAZAVI DENTAL CORPORATION
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Dates
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Enumeration Date | 02/23/2017
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Last Update Date | 04/27/2022
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Provider Practice Location Address
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Address Line | 9506 SEPULVEDA BLVD
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City | NORTH HILLS
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State | CA
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Zip | 91343-3306
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Country | US
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Telephone | 818-830-6181
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Fax |
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Provider Business Mailing Address
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Address Line | 9506 SEPULVEDA BLVD
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City | NORTH HILLS
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State | CA
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Zip | 91343-3306
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | TARANEH RAZAVI
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Credential |
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Telephone | 818-830-6181
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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 | 61843
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License Number State | CA
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