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General NPI Number Information
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NPI Number | 1720713142
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Entity Type | Organization
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Legal Business Name | SARVENAZ ANGHA DDS INC.
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Dates
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Enumeration Date | 07/20/2022
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Last Update Date | 07/22/2022
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Provider Practice Location Address
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Address Line | 200 S EL MOLINO AVE STE 4
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City | PASADENA
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State | CA
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Zip | 91101-2985
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Country | US
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Telephone | 626-788-0006
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Fax |
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Provider Business Mailing Address
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Address Line | 1509 PANDORA AVE
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City | LOS ANGELES
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State | CA
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Zip | 90024-6111
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Country | US
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Telephone | 415-246-8182
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. SARVENAZ ANGHA
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Credential | DDS
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Telephone | 415-246-8182
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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