MEDICARE: IRAVANI DENTISTRY CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry

General Provider Information

NPI Number	:	1134942733
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IRAVANI DENTISTRY CORP

Provider Business Mailing Address
First Line	:	8220 W OLYMPIC BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90006
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2880 W OLYMPIC BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90006-2644
Country	:	US
Telephone Number	:	213-768-9208
Fax Number	:

Authorized Official
Title or Position	:	DOCTOR
Name	:	DR. GOWHAR IRAVANI
Credential	:
Telephone Number	:	818-639-0340

Provider Enumeration Date	:	11/04/2024
Last Update Date	:	12/11/2024

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Directions to “IRAVANI DENTISTRY CORP ” Practice Location

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