Provider Demographics
NPI:1417515008
Name:KOSHKI AND NAMINIK DENTAL CORP
Entity Type:Organization
Organization Name:KOSHKI AND NAMINIK DENTAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MOEIZ
Authorized Official - Middle Name:
Authorized Official - Last Name:KOSHKI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:323-278-0170
Mailing Address - Street 1:711 W WHITTIER BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-4709
Mailing Address - Country:US
Mailing Address - Phone:323-278-0170
Mailing Address - Fax:
Practice Address - Street 1:711 W WHITTIER BLVD
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-4709
Practice Address - Country:US
Practice Address - Phone:323-278-0170
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-30
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental