Provider Demographics
NPI:1033399332
Name:S. EBRAHIMIAN, DDS INC.
Entity Type:Organization
Organization Name:S. EBRAHIMIAN, DDS INC.
Other - Org Name:SHERMAN OAKS DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BOOKKEEPING
Authorized Official - Prefix:
Authorized Official - First Name:THU
Authorized Official - Middle Name:
Authorized Official - Last Name:DANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-387-6387
Mailing Address - Street 1:13949 VENTURA BLVD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423-3584
Mailing Address - Country:US
Mailing Address - Phone:818-385-1999
Mailing Address - Fax:818-385-1988
Practice Address - Street 1:13949 VENTURA BLVD
Practice Address - Street 2:SUITE 250
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91423-3584
Practice Address - Country:US
Practice Address - Phone:818-385-1999
Practice Address - Fax:818-385-1988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-05
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1223G0001X
CA44473305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty