Provider Demographics
NPI:1437344280
Name:DR KOLAHI DENTAL CORP
Entity Type:Organization
Organization Name:DR KOLAHI DENTAL CORP
Other - Org Name:PECK RD DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:MEHRTAJ
Authorized Official - Middle Name:
Authorized Official - Last Name:DABIRI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:626-350-1111
Mailing Address - Street 1:3913 N PECK RD
Mailing Address - Street 2:
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91732
Mailing Address - Country:US
Mailing Address - Phone:626-350-1111
Mailing Address - Fax:626-350-0678
Practice Address - Street 1:3913 N PECK RD
Practice Address - Street 2:PECK RD DENTAL CARE
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91732
Practice Address - Country:US
Practice Address - Phone:626-350-1111
Practice Address - Fax:626-350-1111
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DR KOLAHI DENTAL CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-13
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA348291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty