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General NPI Number Information
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NPI Number | 1639933948
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Entity Type | Organization
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Legal Business Name | B IRAVANI DDS
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Dates
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Enumeration Date | 02/07/2024
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Last Update Date | 01/14/2026
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Provider Practice Location Address
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Address Line | 2880 W OLYMPIC BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90006-2644
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Country | US
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Telephone | 310-962-1119
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Fax |
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Provider Business Mailing Address
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Address Line | 2880 W OLYMPIC BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90006-2644
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Country | US
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Telephone | 310-962-1119
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Fax |
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Authorized Official
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Title or Position | DENTAL ANESTHESIOLOGIST
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Name | DR. BOSHRA SOPHIA IRAVANI
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Credential | DDS
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Telephone | 240-751-3031
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 |
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Taxonomy #2
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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