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General NPI Number Information
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NPI Number | 1427350750
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Entity Type | Individual
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Provider Name | EDWARD A DELSHAD DDS
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Gender | Male
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Dates
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Enumeration Date | 11/18/2010
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Last Update Date | 03/10/2021
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Provider Practice Location Address
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Address Line | 1304 15TH ST STE 206
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City | SANTA MONICA
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State | CA
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Zip | 90404-1811
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Country | US
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Telephone | 310-451-5748
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Fax |
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Provider Business Mailing Address
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Address Line | 9800 VIDOR DR APT 102
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City | LOS ANGELES
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State | CA
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Zip | 90035-1036
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Country | US
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Telephone | 213-973-2040
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 59953
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License Number State | CA
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