MEDICARE: R. MIREBRAHIMIAN, DDS, A PROFESSIONAL DENTAL CORPORATION

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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1871422816
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	R. MIREBRAHIMIAN, DDS, A PROFESSIONAL DENTAL CORPORATION

Provider Business Mailing Address
First Line	:	23111 VENTURA BLVD STE 101
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91364-1126
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	23111 VENTURA BLVD STE 101
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91364-1126
Country	:	US
Telephone Number	:	818-225-7270
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ROZA MIREBRAHIMIAN
Credential	:
Telephone Number	:	818-297-7988

Provider Enumeration Date	:	05/15/2026
Last Update Date	:	05/15/2026

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