Provider Demographics
NPI:1275249138
Name:BAHAREH GOSHAYESHI DDS INC
Entity Type:Organization
Organization Name:BAHAREH GOSHAYESHI DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BAHAREH
Authorized Official - Middle Name:
Authorized Official - Last Name:GOSHAYESHI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-706-8566
Mailing Address - Street 1:3221 CARTER AVE UNIT 367
Mailing Address - Street 2:
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-4963
Mailing Address - Country:US
Mailing Address - Phone:310-706-8566
Mailing Address - Fax:
Practice Address - Street 1:23560 MADISON ST STE 100
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-4709
Practice Address - Country:US
Practice Address - Phone:310-706-8566
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-25
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty