Provider Demographics
NPI:1194026773
Name:DRREYHANIDENTALCORPORATION
Entity Type:Organization
Organization Name:DRREYHANIDENTALCORPORATION
Other - Org Name:DAARDENS DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BEHNOUD
Authorized Official - Middle Name:
Authorized Official - Last Name:REYHANI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-666-9456
Mailing Address - Street 1:1155 S. LAJOLLA AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035
Mailing Address - Country:US
Mailing Address - Phone:310-666-9456
Mailing Address - Fax:562-927-4114
Practice Address - Street 1:7218 GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:BELL GARDENS
Practice Address - State:CA
Practice Address - Zip Code:90201-4812
Practice Address - Country:US
Practice Address - Phone:562-927-4110
Practice Address - Fax:562-927-4114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-12
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56741122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty