Provider Demographics
NPI:1356687305
Name:AHMADI, BORZOO (DDS)
Entity Type:Individual
Prefix:DR
First Name:BORZOO
Middle Name:
Last Name:AHMADI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9201 W SUNSET BLVD STE 710
Mailing Address - Street 2:
Mailing Address - City:BEVELY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90069-3708
Mailing Address - Country:US
Mailing Address - Phone:310-993-8847
Mailing Address - Fax:
Practice Address - Street 1:9201 W SUNSET BLVD STE 710
Practice Address - Street 2:
Practice Address - City:BEVELY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90069-3708
Practice Address - Country:US
Practice Address - Phone:310-562-4746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-19
Last Update Date:2018-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61761122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist