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Organization
TAJIK NAMINIK & KOSHKI DDS INC
Active
Organization
TAJIK NAMINIK & KOSHKI DDS INC
Active
Other names
MODERN SMILES
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KASRA TAJIK DDS (DENTIST)
(818) 763-9395
Entity
Organization
Contact information
Practice address
10545 VICTORY BLVD, NORTH HOLLYWOOD, CA 91606-3916
(818) 763-9353
(818) 763-6227
Mailing address
10545 VICTORY BLVD, NORTH HOLLYWOOD, CA 91606-3916
(818) 763-9353
(818) 763-6227
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
63665
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
44505
LICENCE
CA
01
—
61426
LICENCE
CA
01
—
63665
LICENCE
CA
Enumeration date
04/26/2016
Last updated
04/26/2016
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