MEDICARE: B IRAVANI 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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)
2	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1639933948
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	B IRAVANI DDS

Provider Business Mailing Address
First Line	:	2880 W OLYMPIC BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90006-2644
Country	:	US
Telephone Number	:	310-962-1119
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	:	310-962-1119
Fax Number	:

Authorized Official
Title or Position	:	DENTAL ANESTHESIOLOGIST
Name	:	DR. BOSHRA SOPHIA IRAVANI
Credential	:	DDS
Telephone Number	:	240-751-3031

Provider Enumeration Date	:	02/07/2024
Last Update Date	:	01/14/2026

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Directions to “B IRAVANI DDS ” Practice Location

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