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General NPI Number Information
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NPI Number | 1568668069
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Entity Type | Organization
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Legal Business Name | FARIBA AHMADZADEH DENTAL CORP.
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Dates
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Enumeration Date | 06/22/2007
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Last Update Date | 03/30/2016
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Provider Practice Location Address
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Address Line | 7028 VAN NUYS BLVD
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City | VAN NUYS
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State | CA
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Zip | 91405-3059
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Country | US
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Telephone | 818-780-8555
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Fax | 818-780-8477
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Provider Business Mailing Address
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Address Line | 7028 VAN NUYS BLVD
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City | VAN NUYS
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State | CA
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Zip | 91405-3059
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Country | US
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Telephone | 818-780-8555
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Fax | 818-780-8477
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Authorized Official
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Title or Position | 0WNER
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Name | DR. FARIBA AHMADZADEH
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Credential | D.D.S
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Telephone | 818-780-8555
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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 | 45349
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License Number State | CA
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