Provider Demographics
NPI:1215543327
Name:ANAHITA BEHSHADPOUR DENTAL CORPORATION
Entity Type:Organization
Organization Name:ANAHITA BEHSHADPOUR DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANAHITA
Authorized Official - Middle Name:
Authorized Official - Last Name:BEHSHADPOUR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-669-4200
Mailing Address - Street 1:5354 YARMOUTH AVE APT 27
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-3173
Mailing Address - Country:US
Mailing Address - Phone:818-669-4200
Mailing Address - Fax:
Practice Address - Street 1:14435 HAMLIN ST STE 205
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91401-6205
Practice Address - Country:US
Practice Address - Phone:818-669-4200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty