Provider Demographics
NPI:1487024519
Name:MAGHIRAN DENTAL CORP
Entity Type:Organization
Organization Name:MAGHIRAN DENTAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:MR
Authorized Official - First Name:GANI
Authorized Official - Middle Name:ALVERO
Authorized Official - Last Name:MAGHIRAN
Authorized Official - Suffix:
Authorized Official - Credentials:OFFICE MANAGER
Authorized Official - Phone:818-486-8093
Mailing Address - Street 1:9506 SEPULVEDA BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91343-3306
Mailing Address - Country:US
Mailing Address - Phone:818-891-1136
Mailing Address - Fax:818-830-5471
Practice Address - Street 1:9506 SEPULVEDA BLVD
Practice Address - Street 2:
Practice Address - City:NORTH HILLS
Practice Address - State:CA
Practice Address - Zip Code:91343-3306
Practice Address - Country:US
Practice Address - Phone:818-891-1136
Practice Address - Fax:818-830-5471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-01
Last Update Date:2015-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44029302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB4402901OtherDENTICAL