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General NPI Number Information
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NPI Number | 1669068201
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Entity Type | Organization
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Legal Business Name | F EDALATPAJOUH DENTAL INC
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Dates
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Enumeration Date | 12/17/2020
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Last Update Date | 03/23/2021
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Provider Practice Location Address
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Address Line | 4332 SLAUSON AVE
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City | MAYWOOD
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State | CA
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Zip | 90270-2848
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Country | US
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Telephone | 310-529-7292
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Fax |
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Provider Business Mailing Address
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Address Line | 4332 SLAUSON AVE
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City | MAYWOOD
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State | CA
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Zip | 90270-2848
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Country | US
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Telephone | 323-771-7777
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | 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 |
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Taxonomy #2
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Taxonomy Code | 1223D0001X
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Taxonomy Name | Public Health Dentistry
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License Number |
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License Number State |
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Taxonomy #3
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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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