Provider Demographics
NPI:1083869382
Name:REZA RADMAND D.M.D INC.
Entity Type:Organization
Organization Name:REZA RADMAND D.M.D INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:REZA
Authorized Official - Middle Name:
Authorized Official - Last Name:RADMAND
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:626-480-7777
Mailing Address - Street 1:4070 STERLING WAY
Mailing Address - Street 2:
Mailing Address - City:BALDWIN PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91706-4223
Mailing Address - Country:US
Mailing Address - Phone:626-480-7777
Mailing Address - Fax:
Practice Address - Street 1:4070 STERLING WAY
Practice Address - Street 2:
Practice Address - City:BALDWIN PARK
Practice Address - State:CA
Practice Address - Zip Code:91706-4223
Practice Address - Country:US
Practice Address - Phone:626-480-7777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-01
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38118122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty