Provider Demographics
NPI:1447750963
Name:SAHABI-MORAVVEJI DENTAL CORPORATION
Entity Type:Organization
Organization Name:SAHABI-MORAVVEJI DENTAL CORPORATION
Other - Org Name:CALIFORNIA DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KAMRAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SAHABI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-395-4833
Mailing Address - Street 1:4701 EAGLE ROCK BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90041-2711
Mailing Address - Country:US
Mailing Address - Phone:818-395-4833
Mailing Address - Fax:818-790-3885
Practice Address - Street 1:2101 BROADVIEW DR
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91208-1313
Practice Address - Country:US
Practice Address - Phone:818-395-3833
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-21
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty