Provider Demographics
NPI:1417070087
Name:PARTOVI, MAHTAB (DDS)
Entity Type:Individual
Prefix:DR
First Name:MAHTAB
Middle Name:
Last Name:PARTOVI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1575 WESTWOOD BLVD
Mailing Address - Street 2:# 305
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-5620
Mailing Address - Country:US
Mailing Address - Phone:310-663-2923
Mailing Address - Fax:
Practice Address - Street 1:1575 WESTWOOD BLVD
Practice Address - Street 2:# 305
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-5620
Practice Address - Country:US
Practice Address - Phone:310-663-2292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2009-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54424122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist