Organization
EBI NIKJOO DENTAL CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EDI DONOVAN NIKJOO (CEO)
(818) 782-5501
Entity
Organization
Contact information
Practice address
13549 ROSCOE BLVD, PANORAMA CITY, CA 91402-5500
(818) 782-5501
Mailing address
13549 ROSCOE BLVD, PANORAMA CITY, CA 91402-5500
(818) 782-5501
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
09/02/2015
Last updated
12/03/2015
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