Provider Demographics
NPI:1376541482
Name:FOROUTAN, JOHN H (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:H
Last Name:FOROUTAN
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 1:18308 SHERMAN WAY
Mailing Address - Street 2:STE 1
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-4475
Mailing Address - Country:US
Mailing Address - Phone:818-881-0404
Mailing Address - Fax:818-881-7108
Practice Address - Street 1:18308 SHERMAN WAY
Practice Address - Street 2:STE 1
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-4475
Practice Address - Country:US
Practice Address - Phone:818-881-0404
Practice Address - Fax:818-881-7108
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32956122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA32956OtherDENTAL LICENSE