Provider Demographics
NPI:1275887812
Name:COHEN, MANAVI & PAKRAVAN INC
Entity Type:Organization
Organization Name:COHEN, MANAVI & PAKRAVAN INC
Other - Org Name:PEAK DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FARID
Authorized Official - Middle Name:
Authorized Official - Last Name:PAKRAVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-820-9933
Mailing Address - Street 1:17525 HIGHWAY 99
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98037-3105
Mailing Address - Country:US
Mailing Address - Phone:310-820-9933
Mailing Address - Fax:310-820-0408
Practice Address - Street 1:17525 HIGHWAY 99
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98037-3105
Practice Address - Country:US
Practice Address - Phone:310-820-9933
Practice Address - Fax:310-820-0408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-05
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39862122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty