Provider Demographics
NPI:1205000940
Name:NOUSHIN ADHAMI DENTAL CORPORATION
Entity Type:Organization
Organization Name:NOUSHIN ADHAMI DENTAL CORPORATION
Other - Org Name:VISTASOL DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:DR
Authorized Official - First Name:NOUSHIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ADHAMI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:323-342-0208
Mailing Address - Street 1:1000 W WHITTIER BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-4639
Mailing Address - Country:US
Mailing Address - Phone:323-342-0208
Mailing Address - Fax:323-346-0211
Practice Address - Street 1:1000 W WHITTIER BLVD
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-4639
Practice Address - Country:US
Practice Address - Phone:323-342-0208
Practice Address - Fax:323-346-0211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-14
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA474381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty