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Organization
KELISHADI SAMANI DENTAL CORP
Active
Organization
KELISHADI SAMANI DENTAL CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARJAN KELISHADI DDS (DENTIST)
(310) 830-3500
Entity
Organization
Contact information
Practice address
23541 AVALON BLVD, CARSON, CA 90745
(310) 830-3500
(310) 830-7994
Mailing address
23541 AVALON BLVD, CARSON, CA 90745
(310) 830-3500
(310) 830-7994
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
41930
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
612331200
AFFILIATED COMPUTER SERVI
CA
01
—
809101
UNITED CONCORDIA
CA
05
—
G9300701
—
CA
01
—
G9805001
HEALTHY FAMILIES
CA
Enumeration date
06/07/2007
Last updated
07/03/2008
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