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Organization
MEHRZAD FIROUZBAKHT DENTAL,INC
Active
Organization
MEHRZAD FIROUZBAKHT DENTAL,INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MEHRZAD FIROUZBAKHT DDS (PRESIDENT)
(818) 908-9199
Entity
Organization
Contact information
Practice address
14100 VICTORY BLVD, VAN NUYS, CA 91401-1958
(818) 908-9199
Mailing address
14100 VICTORY BLVD, VAN NUYS, CA 91401-1958
(818) 908-9199
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
55616
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1326221615
DENTAL PROVIDER
CA
Enumeration date
08/12/2008
Last updated
08/12/2008
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