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Organization
MASTOUR & FARD DENTAL CORP
Active
Organization
MASTOUR & FARD DENTAL CORP
Active
Other names
Community Dental Group, Inc.
Organization subpart
No
Provider details
NPI number
Authorized official
PEDRAM MASTOUR DDS (OWNER)
(310) 804-0414
Entity
Organization
Contact information
Practice address
587 N. VENTU PARK ROAD., SUITE C, NEWBERRY PARK, CA 91320
(805) 499-1253
(805) 499-1453
Mailing address
5620 SAWTELLE BLVD, CULVER CITY, CA 90230-5508
(310) 390-6212
(310) 390-6215
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
—
—
Other
Enumeration date
12/04/2018
Last updated
10/23/2019
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