MEDICARE: DR. PEDRAM S MASTOUR DDS

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	122300000X	Dentist	47525	CA

General Provider Information

NPI Number	:	1548582026
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PEDRAM S MASTOUR DDS

Provider Business Mailing Address
First Line	:	5620 SAWTELLE BLVD
Second Line	:
City	:	CULVER CITY
State	:	CA
Zip	:	90230-5508
Country	:	US
Telephone Number	:	310-390-6212
Fax Number	:	310-390-6215

Provider Business Practice Location Address
First Line	:	5620 SAWTELLE BLVD
Second Line	:
City	:	CULVER CITY
State	:	CA
Zip	:	90230-5508
Country	:	US
Telephone Number	:	310-390-6212
Fax Number	:	310-390-6215

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/24/2010
Last Update Date	:	05/04/2016

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