Provider Demographics
NPI:1215605845
Name:S. SHAUN DANESHGAR DMD INC
Entity Type:Organization
Organization Name:S. SHAUN DANESHGAR DMD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DANESHGAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-835-6123
Mailing Address - Street 1:2771 E FLORENCE AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90255-5750
Mailing Address - Country:US
Mailing Address - Phone:310-701-0770
Mailing Address - Fax:
Practice Address - Street 1:2505 E CESAR E CHAVEZ AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-3003
Practice Address - Country:US
Practice Address - Phone:310-701-0770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-30
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental