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General NPI Number Information
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NPI Number | 1427572841
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Entity Type | Organization
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Legal Business Name | ARJANG DENTAL CORPORATION
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Dates
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Enumeration Date | 07/27/2017
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Last Update Date | 07/27/2017
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Provider Practice Location Address
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Address Line | 415 W BEVERLY BLVD STE B
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City | MONTEBELLO
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State | CA
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Zip | 90640-3667
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Country | US
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Telephone | 310-968-1866
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Fax |
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Provider Business Mailing Address
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Address Line | 1233 SAN VICENTE BLVD
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City | SANTA MONICA
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State | CA
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Zip | 90402-2103
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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 | DR. DANIELLE FARZAM
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Credential |
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Telephone | 310-968-1866
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 62618
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License Number State | CA
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