Provider Demographics
NPI:1306010194
Name:KAMIAR H. DEHKORDI A PROFESSIONAL CORPORATION DDS
Entity Type:Organization
Organization Name:KAMIAR H. DEHKORDI A PROFESSIONAL CORPORATION DDS
Other - Org Name:FRESH SMILE DENTAL CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAMIAR
Authorized Official - Middle Name:H
Authorized Official - Last Name:DEHKORDI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-252-7222
Mailing Address - Street 1:8215 SUNLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:SUN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91352-3362
Mailing Address - Country:US
Mailing Address - Phone:818-252-7222
Mailing Address - Fax:
Practice Address - Street 1:8215 SUNLAND BLVD
Practice Address - Street 2:
Practice Address - City:SUN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91352-3362
Practice Address - Country:US
Practice Address - Phone:818-252-7222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-14
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA537821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty