Provider Demographics
NPI:1134672421
Name:SHAYESTEH & SHAMS CULVER CITY DENTAL CORPORATION
Entity Type:Organization
Organization Name:SHAYESTEH & SHAMS CULVER CITY DENTAL CORPORATION
Other - Org Name:PICASSO SMILES DENTAL COSMETIC & IMPLANT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:NIMA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAYESTEH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:310-663-6989
Mailing Address - Street 1:10842 WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90232-3610
Mailing Address - Country:US
Mailing Address - Phone:310-663-6989
Mailing Address - Fax:915-857-6456
Practice Address - Street 1:10842 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90232-3610
Practice Address - Country:US
Practice Address - Phone:310-663-6989
Practice Address - Fax:915-857-6456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-03
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA570351223G0001X
CA567121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty