# FARID PAKRAVAN PROFESSIONAL DENTAL CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Other names:** WEST COAST DENTAL & ORTHODONTICS, ADULT & KIDS DENTAL GROUP
- **Organization subpart:** No

## Provider details

- **NPI number:** 1811691710
- **Authorized official:** MIGUEL REYES (Q/A CONTRACT & COMPLIANCE MANAGER)
- **Authorized official phone:** (310) 409-4225

## Contact information

- **Practice address:** 2015 W 1ST ST STE E, SANTA ANA, CA 92703-3504
- **Practice address phone:** (310) 820-9933
- **Practice address fax:** (310) 820-0408
- **Mailing address:** 12121 WILSHIRE BLVD STE 1111, LOS ANGELES, CA 90025-1188
- **Mailing address phone:** (310) 820-9933

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | NULL | Yes |
| 122300000X | Dentist | — | — | Yes |

## Other

- **Enumeration date:** 03/27/2023
- **Last updated:** 02/02/2024