=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750949210
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NAZARIAN AND IRAVANI DENTAL PARTNERSHIP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/30/2019
-----------------------------------------------------
Last Update Date | 05/31/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8111 VAN NUYS BLVD. 107
-----------------------------------------------------
City | PANORAMA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91402-4812
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-616-3902
-----------------------------------------------------
Fax | 818-616-3908
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8111 VAN NUYS BLVD. 107
-----------------------------------------------------
City | PANORAMA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91402-4812
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-616-3902
-----------------------------------------------------
Fax | 818-616-3908
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST
-----------------------------------------------------
Name | DR. CARINEH NAZARIAN
-----------------------------------------------------
Credential | D.D.S.
-----------------------------------------------------
Telephone | 805-584-8444
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------