Organization
DDS DENTAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SADI KERMANI (DELEGATED REPRSENTATIVE)
(213) 314-6612
Entity
Organization
Contact information
Practice address
140 S ROBERTSON BLVD, LOS ANGELES, CA 90048-3208
(213) 314-6612
Mailing address
140 S ROBERTSON BLVD, LOS ANGELES, CA 90048-3208
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00000-00000
—
CA
Enumeration date
04/02/2019
Last updated
06/11/2019
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