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Organization
PAKRAVAN, MANAVI & COHEN DENTAL CORPORATION
Active
Organization
PAKRAVAN, MANAVI & COHEN DENTAL CORPORATION
Active
Other names
MAGICLAND DENTAL GROUP OF RIALTO
Organization subpart
No
Provider details
NPI number
Authorized official
MIGUEL REYES (Q/A CONTRACT & COMPLIANCE MANAGER)
(310) 820-9933
Entity
Organization
Contact information
Practice address
1205 W RENAISSANCE PKWY, SUITE 240, RIALTO, CA 92376
(310) 820-9933
(310) 820-0408
Mailing address
12121 WILSHIRE BLVD STE 1111, LOS ANGELES, CA 90025-1188
(310) 409-4225
(310) 820-0408
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
CA
Other
Enumeration date
08/20/2018
Last updated
07/30/2020
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