Organization
MORTEZAIEFARD DENTAL CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GOLSAHN MORTEZAIEFARD (OWNER)
(818) 888-4004
Entity
Organization
Contact information
Practice address
22110 ROSCOE BLVD STE 101, WEST HILLS, CA 91304-3859
(818) 888-4004
Mailing address
22110 ROSCOE BLVD STE 101, WEST HILLS, CA 91304-3859
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
B39049
CA
Other
Enumeration date
06/05/2008
Last updated
06/05/2008
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