Provider Demographics
NPI:1235385113
Name:MEHRZAD FIROUZBAKHT DENTAL,INC
Entity Type:Organization
Organization Name:MEHRZAD FIROUZBAKHT DENTAL,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MEHRZAD
Authorized Official - Middle Name:
Authorized Official - Last Name:FIROUZBAKHT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-908-9199
Mailing Address - Street 1:14100 VICTORY BLVD
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91401-1958
Mailing Address - Country:US
Mailing Address - Phone:818-908-9199
Mailing Address - Fax:
Practice Address - Street 1:14100 VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91401-1958
Practice Address - Country:US
Practice Address - Phone:818-908-9199
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-12
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA556161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1326221615OtherDENTAL PROVIDER