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General NPI Number Information
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NPI Number | 1477466597
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Entity Type | Organization
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Legal Business Name | F EDALATPAJOUH DENTAL 3 INC
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Dates
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Enumeration Date | 09/28/2026
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Last Update Date | 09/28/2026
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Provider Practice Location Address
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Address Line | 5037 LAKEWOOD BLVD
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City | LAKEWOOD
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State | CA
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Zip | 90712-2412
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Country | US
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Telephone | 562-531-0221
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Fax |
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Provider Business Mailing Address
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Address Line | 5037 LAKEWOOD BLVD
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City | LAKEWOOD
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State | CA
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Zip | 90712-2412
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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 | CCO
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Name | DR. RYAN EDALATPAJOUH
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Credential | DDS
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Telephone | 310-529-7292
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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 | NULL
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