Organization
FARID PAKRAVAN PROFESSIONAL DENTAL CORPORATION
Active
Other names
MAGICLAND CHILDREN'S DENTISTRY & ORTHODONTICS DENTAL GROUP
Organization subpart
No
Provider details
NPI number
Authorized official
MIGUEL REYES (Q/A CONTRACT & COMPLIANCE MANAGER)
(310) 409-4225
Entity
Organization
Contact information
Practice address
6423 VINELAND AVE, NORTH HOLLYWOOD, CA 91606-2712
(310) 820-9933
(310) 820-0408
Mailing address
12121 WILSHIRE BLVD STE 1111, LOS ANGELES, CA 90025-1188
(310) 820-9933
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Enumeration date
12/21/2022
Last updated
04/20/2023
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