=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982005542
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SAHAR VERDI DDS DENTAL CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/12/2014
-----------------------------------------------------
Last Update Date | 09/12/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 120 S SPALDING DR SUITE 201
-----------------------------------------------------
City | BEVERLY HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90212-1800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-285-0855
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 120 S SPALDING DR SUITE 201
-----------------------------------------------------
City | BEVERLY HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90212-1800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-285-0855
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | SAHAR VERDI
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 310-285-0855
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0300X
-----------------------------------------------------
Taxonomy Name | Periodontics
-----------------------------------------------------
License Number | 51775
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------