Provider Demographics
NPI:1295853224
Name:MASROUR-RAD, MORAD I (DMD)
Entity Type:Individual
Prefix:DR
First Name:MORAD
Middle Name:
Last Name:MASROUR-RAD
Suffix:I
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6325 TOPANGA CANYON BLVD
Mailing Address - Street 2:#310
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-2004
Mailing Address - Country:US
Mailing Address - Phone:818-884-4224
Mailing Address - Fax:818-884-4441
Practice Address - Street 1:6325 TOPANGA CANYON BLVD
Practice Address - Street 2:#310
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-2004
Practice Address - Country:US
Practice Address - Phone:818-884-4224
Practice Address - Fax:818-884-4441
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA305791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice