Organization
BAMSHAD DENTAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEYVAN BAMSHAD DDS (OWNER/ DENTIST)
(818) 345-6477
Entity
Organization
Contact information
Practice address
253 LOMBARD ST STE A, THOUSAND OAKS, CA 91360-8232
(805) 496-3113
(805) 496-3616
Mailing address
253 LOMBARD ST STE A, THOUSAND OAKS, CA 91360-8232
(805) 496-3113
(805) 496-3616
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
46553
CA
Other
Enumeration date
07/24/2018
Last updated
07/24/2018
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