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General NPI Number Information
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NPI Number | 1861932998
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Entity Type | Organization
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Legal Business Name | MAKHMALBAF & MIRMARASHI DENTAL PARTNERSHIP
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Dates
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Enumeration Date | 03/08/2017
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Last Update Date | 03/09/2017
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Provider Practice Location Address
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Address Line | 10921 WILSHIRE BLVD STE 501
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City | LOS ANGELES
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State | CA
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Zip | 90024-4001
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Country | US
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Telephone | 310-443-3030
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Fax | 310-443-5660
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Provider Business Mailing Address
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Address Line | 10921 WILSHIRE BLVD STE 501
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City | LOS ANGELES
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State | CA
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Zip | 90024-4001
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Country | US
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Telephone | 310-443-3030
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Fax | 310-443-5660
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Authorized Official
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Title or Position | DENTIST
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Name | DR. ALI O. MAKHMALBAF
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Credential | DDS
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Telephone | 310-443-3030
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 59489
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 59489
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License Number State | CA
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