Provider Demographics
NPI:1376909002
Name:ESHAGHIAN & PAZOOKY DENTAL CORPORATION
Entity Type:Organization
Organization Name:ESHAGHIAN & PAZOOKY DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHARONE
Authorized Official - Middle Name:
Authorized Official - Last Name:PAZOOKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-933-6033
Mailing Address - Street 1:2978 WILSHIRE BLVD
Mailing Address - Street 2:#201
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-1126
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2978 WILSHIRE BLVD
Practice Address - Street 2:#201
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-1126
Practice Address - Country:US
Practice Address - Phone:310-933-6033
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-11
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59650122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty