Provider Demographics
NPI:1225609514
Name:RADMANESH DENTAL PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:RADMANESH DENTAL PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PARHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:RADMANESH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:857-264-8063
Mailing Address - Street 1:1267 WILLIS ST STE 200
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-0400
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:33 E CONCORD ST UNIT 2
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-1905
Practice Address - Country:US
Practice Address - Phone:857-264-8063
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-07
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty