MEDICARE: A SABBAGH-FARD DDS & P. MASTOUR DDS INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	1223P0300X	Periodontics	CA
2	305R00000X	Preferred Provider Organization	CA
3	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	CA
4	122300000X	Dentist	CA

General Provider Information

NPI Number	:	1568710333
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A SABBAGH-FARD DDS & P. MASTOUR DDS INC

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	:	DENTIST
Name	:	DR. PEDRAM E. MASTOUR
Credential	:	D.D.S
Telephone Number	:	310-390-6212

Provider Enumeration Date	:	08/27/2012
Last Update Date	:	07/21/2022

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