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General NPI Number Information
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NPI Number | 1669954566
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Entity Type | Organization
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Legal Business Name | ASTARAEE DENTAL CORP
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Dates
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Enumeration Date | 09/06/2018
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Last Update Date | 12/12/2024
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Provider Practice Location Address
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Address Line | 11980 SAN VICENTE BLVD STE 819
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City | LOS ANGELES
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State | CA
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Zip | 90049-6606
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Country | US
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Telephone | 424-372-9159
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Fax |
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Provider Business Mailing Address
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Address Line | 11870 SANTA MONICA BLVD STE 106418
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City | LOS ANGELES
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State | CA
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Zip | 90025-2276
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DENTIST/CEO
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Name | NIMA ASTARAEE
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Credential |
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Telephone | 619-261-3933
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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 | DDS101265
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License Number State | CA
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