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General NPI Number Information
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NPI Number | 1568710333
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Entity Type | Organization
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Legal Business Name | A SABBAGH-FARD DDS & P. MASTOUR DDS INC
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Dates
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Enumeration Date | 08/27/2012
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 5620 SAWTELLE BLVD
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City | CULVER CITY
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State | CA
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Zip | 90230-5508
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Country | US
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Telephone | 310-390-6212
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Fax | 310-390-6215
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Provider Business Mailing Address
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Address Line | 5620 SAWTELLE BLVD
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City | CULVER CITY
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State | CA
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Zip | 90230-5508
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Country | US
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Telephone | 310-390-6212
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Fax | 310-390-6215
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Authorized Official
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Title or Position | DENTIST
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Name | DR. PEDRAM E. MASTOUR
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Credential | D.D.S
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Telephone | 310-390-6212
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number |
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State | CA
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Taxonomy #4
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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 | CA
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