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General NPI Number Information
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NPI Number | 1700215514
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Entity Type | Organization
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Legal Business Name | AIRPORT DENTAL CARE, PRACTICE OF DR. MOHAMMADI DDS, INC
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Dates
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Enumeration Date | 11/02/2013
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Last Update Date | 11/02/2013
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Provider Practice Location Address
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Address Line | 1117 W MANCHESTER BLVD UNIT O
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City | INGLEWOOD
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State | CA
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Zip | 90301-1500
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Country | US
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Telephone | 213-271-0390
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Fax |
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Provider Business Mailing Address
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Address Line | 1117 W MANCHESTER BLVD UNIT O
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City | INGLEWOOD
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State | CA
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Zip | 90301-1500
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Country | US
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Telephone | 213-271-0390
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. MOHAMMAD MEHDI MOHAMMADI
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Credential | DDS
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Telephone | 213-271-0390
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 61402
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License Number State | CA
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