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General NPI Number Information
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NPI Number | 1609045939
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Entity Type | Organization
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Legal Business Name | BEHNAZ SEPEHRIPOUR, DDS A PROFESSIONAL DENTAL CORPORATION
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Dates
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Enumeration Date | 02/20/2008
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Last Update Date | 01/09/2017
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Provider Practice Location Address
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Address Line | 8320 DESOTO AVE
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City | CANOGA PARK
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State | CA
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Zip | 91304-2701
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Country | US
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Telephone | 818-883-1234
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Fax | 818-883-9781
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Provider Business Mailing Address
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Address Line | 8320 DESOTO AVE
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City | CANOGA PARK
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State | CA
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Zip | 91304-1746
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Country | US
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Telephone | 818-883-1234
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Fax | 818-883-9781
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Authorized Official
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Title or Position | OWNER DENTIST
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Name | DR. BEHNAZ SEPEHRIPOUR
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Credential | DDS
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Telephone | 818-883-1234
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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 | 42224
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License Number State | CA
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