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General NPI Number Information
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NPI Number | 1811359615
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Entity Type | Organization
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Legal Business Name | KHODADADI, ALIREZAEI AND KEIHANI DENTAL CORP
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Dates
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Enumeration Date | 03/22/2016
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Last Update Date | 06/13/2016
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Provider Practice Location Address
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Address Line | 1730 E GONZALES RD
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City | OXNARD
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State | CA
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Zip | 93036-3701
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Country | US
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Telephone | 805-604-9999
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Fax | 805-364-4677
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Provider Business Mailing Address
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Address Line | 1730 E GONZALES RD
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City | OXNARD
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State | CA
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Zip | 93036-3701
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Country | US
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Telephone | 805-604-9999
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Fax | 805-364-4677
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Authorized Official
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Title or Position | PRESIDENT/DENTIST
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Name | DR. KOUROSH KEIHANI
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Credential | D.D.S
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Telephone | 310-562-2046
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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 | 39024
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 48872
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License Number State | CA
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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 | 63776
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License Number State | CA
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