Provider Demographics
NPI:1154450005
Name:BINAFARD KHALILI DENTAL CORP
Entity Type:Organization
Organization Name:BINAFARD KHALILI DENTAL CORP
Other - Org Name:BINAFARD DENTALAND CORPORATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BEHZAD
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:BINAFARD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:323-585-1000
Mailing Address - Street 1:7136 PACIFIC BLVD
Mailing Address - Street 2:210
Mailing Address - City:HUNTINGTON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90255-4783
Mailing Address - Country:US
Mailing Address - Phone:323-585-1000
Mailing Address - Fax:323-585-5391
Practice Address - Street 1:7136 PACIFIC BLVD
Practice Address - Street 2:210
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-4783
Practice Address - Country:US
Practice Address - Phone:323-585-1000
Practice Address - Fax:323-585-5391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37388122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty