Organization
F EDALATPAJOUH DENTAL INC
Active
Other names
F Edalat Dental Inc.
Organization subpart
No
Provider details
NPI number
Authorized official
RYAN EDALATPAJOUH DDS (PRESIDENT)
(310) 529-7292
Entity
Organization
Contact information
Practice address
4332 SLAUSON AVE, MAYWOOD, CA 90270-2848
(310) 529-7292
Mailing address
4332 SLAUSON AVE, MAYWOOD, CA 90270-2848
(323) 771-7777
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
—
—
1223D0001X
Public Health Dentistry
—
—
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1225551351
FARAZ EDALATPAJOUH
CA
05
—
1225551351
—
CA
Enumeration date
12/17/2020
Last updated
03/23/2021
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