Organization
POOYAN NASIBI DENTAL INC
Active
Other names
Huntington Park Children's Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
DR. POOYAN NASIBI DDS (OWNER)
(424) 208-4055
Entity
Organization
Contact information
Practice address
5501 PACIFIC BLVD, HUNTINGTON PARK, CA 90255-2534
(323) 597-1135
(323) 372-9295
Mailing address
5501 PACIFIC BLVD, HUNTINGTON PARK, CA 90255-2534
(323) 597-1135
(323) 372-9295
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
—
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
—
—
Other
Enumeration date
05/22/2025
Last updated
05/22/2025
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