Individual
TARA AGHALOO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS, MD, PHD
Contact information
Practice address
10833 LE CONTE AVE, ROOM A0-156, LOS ANGELES, CA 90095-3075
(310) 794-7070
(310) 825-7232
Mailing address
5767 W CENTURY BLVD, SUITE 400, LOS ANGELES, CA 90045-5631
(310) 825-0834
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
42718
CA
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
42718
CA
Other
Enumeration date
12/27/2007
Last updated
03/26/2013
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