Provider Demographics
NPI:1467531889
Name:MASOOD IMANUEL DMD A DENTAL CORPORATION
Entity Type:Organization
Organization Name:MASOOD IMANUEL DMD A DENTAL CORPORATION
Other - Org Name:UNITED FAMILY DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SIMON
Authorized Official - Middle Name:MASOOD
Authorized Official - Last Name:IMANUEL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:818-899-9999
Mailing Address - Street 1:14150 VAN NUYS BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:ARLETA
Mailing Address - State:CA
Mailing Address - Zip Code:91331-5114
Mailing Address - Country:US
Mailing Address - Phone:818-899-9999
Mailing Address - Fax:818-897-0859
Practice Address - Street 1:14150 VAN NUYS BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:ARLETA
Practice Address - State:CA
Practice Address - Zip Code:91331-5114
Practice Address - Country:US
Practice Address - Phone:818-899-9999
Practice Address - Fax:818-897-0859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-05
Last Update Date:2015-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39418122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG9123601Medicaid