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Organization
KHOSHROZEH DENTAL CORPORATION
Active
Organization
KHOSHROZEH DENTAL CORPORATION
Active
Other names
CALIFORNIA FAMILY DENTAL GROUP
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MEHRDAD KHOSHROZEH (OWNER/ PRESIDENT)
(310) 386-8246
Entity
Organization
Contact information
Practice address
4080 WHITTIER BLVD, LOS ANGELES, CA 90023-2527
(323) 582-4744
(323) 582-3101
Mailing address
4080 WHITTIER BLVD, LOS ANGELES, CA 90023-2527
(323) 582-4474
(323) 582-3101
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
49906
CA
1223G0001X
General Practice Dentistry
43515
CA
1223G0001X
General Practice Dentistry
Primary
43990
CA
1223G0001X
General Practice Dentistry
49909
CA
1223P0221X
Pediatric Dentistry
53064
CA
1223P0221X
Pediatric Dentistry
53901
CA
1223P0300X
Periodontics
30624
CA
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
73479
CA
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
A91274
CA
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
20482
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
G91571-01
DENTICAL OFFICE NUMBER
CA
Enumeration date
01/30/2007
Last updated
11/16/2020
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