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General NPI Number Information
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NPI Number | 1861907966
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Entity Type | Organization
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Legal Business Name | NADIA E. TAHERI DENTAL CORPORATION
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Dates
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Enumeration Date | 12/11/2017
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 12903 VICTORY BLVD
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City | NORTH HOLLYWOOD
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State | CA
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Zip | 91606-2923
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Country | US
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Telephone | 785-979-8800
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Fax |
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Provider Business Mailing Address
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Address Line | 12903 VICTORY BLVD
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City | NORTH HOLLYWOOD
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State | CA
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Zip | 91606-2923
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Country | US
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Telephone | 818-999-3805
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Fax | 818-999-3805
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Authorized Official
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Title or Position | DENTIST
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Name | NADIA E. TAHERI
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Credential | DDS
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Telephone | 818-999-3805
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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 | 10045
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License Number State | CA
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