Provider Demographics
NPI:1063632669
Name:HOUTAN HOSSEINI DENTAL CORPORATION
Entity Type:Organization
Organization Name:HOUTAN HOSSEINI DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:HOUTAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOSSEINI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:661-324-1000
Mailing Address - Street 1:2016 E ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-4223
Mailing Address - Country:US
Mailing Address - Phone:661-324-1000
Mailing Address - Fax:661-324-1199
Practice Address - Street 1:2016 E ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-4223
Practice Address - Country:US
Practice Address - Phone:661-324-1000
Practice Address - Fax:661-324-1199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41923305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization