Provider Demographics
NPI:1104360882
Name:SEAN EBRAHIMIAN DDS, INC.
Entity Type:Organization
Organization Name:SEAN EBRAHIMIAN DDS, INC.
Other - Org Name:PURE DENTISTRY KIDS & ADULTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHAHAB
Authorized Official - Middle Name:
Authorized Official - Last Name:EBRAHIMIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-385-1999
Mailing Address - Street 1:13949 VENTURA BLVD
Mailing Address - Street 2:STE 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:818-386-8375
Practice Address - Street 1:26457 BOUQUET CANYON RD
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91350-2396
Practice Address - Country:US
Practice Address - Phone:661-513-9393
Practice Address - Fax:661-667-4413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-14
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA444731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty