Provider Demographics
NPI:1417613746
Name:BENJAMIN POURMORADY DDS A PROFESSIONAL CORPORATION INC.
Entity Type:Organization
Organization Name:BENJAMIN POURMORADY DDS A PROFESSIONAL CORPORATION INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:POURMORADY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-801-5828
Mailing Address - Street 1:144 N WILLAMAN DR
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-2113
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6200 WILSHIRE BLVD STE 1109
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5812
Practice Address - Country:US
Practice Address - Phone:323-238-8114
Practice Address - Fax:323-933-3268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-10
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental