Provider Demographics
NPI:1225463037
Name:MIKE PIRBAZARI, DDS. PHD, INC.
Entity Type:Organization
Organization Name:MIKE PIRBAZARI, DDS. PHD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ENDODONTIST/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:PIRBAZARI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, PHD
Authorized Official - Phone:818-436-2986
Mailing Address - Street 1:269 S. BEVERLY DR.
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212
Mailing Address - Country:US
Mailing Address - Phone:310-339-3836
Mailing Address - Fax:
Practice Address - Street 1:7301 MEDICAL CENTER DR. SUITE 305
Practice Address - Street 2:
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307
Practice Address - Country:US
Practice Address - Phone:818-436-2986
Practice Address - Fax:818-887-5695
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MIKE PIRBAZARI, DDS, PH. D, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-09-11
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA354471223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty