Provider Demographics
NPI:1164646618
Name:PARID PAKRAVAN DENTAL CORPORATION
Entity Type:Organization
Organization Name:PARID PAKRAVAN DENTAL CORPORATION
Other - Org Name:WEST COAST DENTAL GROUP OF LYNWOOD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FARID
Authorized Official - Middle Name:
Authorized Official - Last Name:PAKRAVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-563-8900
Mailing Address - Street 1:9910 LONG BEACH BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:LYNWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90262-1561
Mailing Address - Country:US
Mailing Address - Phone:323-563-8900
Mailing Address - Fax:323-563-3434
Practice Address - Street 1:9910 LONG BEACH BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:LYNWOOD
Practice Address - State:CA
Practice Address - Zip Code:90262-1561
Practice Address - Country:US
Practice Address - Phone:323-563-8900
Practice Address - Fax:323-563-3434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA398621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty