Provider Demographics
NPI:1063844942
Name:MIKE PIRBAZARI, DDS, PHD. INC
Entity Type:Organization
Organization Name:MIKE PIRBAZARI, DDS, PHD. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMDODONTIST, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:PIRBAZARI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, PHD
Authorized Official - Phone:310-264-1711
Mailing Address - Street 1:269 S. BEVERLY DR.,
Mailing Address - Street 2:SUITE 436
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212
Mailing Address - Country:US
Mailing Address - Phone:310-339-3836
Mailing Address - Fax:
Practice Address - Street 1:1807 WILSHIRE BLVD.,
Practice Address - Street 2:SUITE A
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403
Practice Address - Country:US
Practice Address - Phone:310-264-1711
Practice Address - Fax:310-453-6486
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MIKE PIRBAZARI , DDS, PHD, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-08-02
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA354471223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty