Provider Demographics
NPI:1497228555
Name:MOEIZ KOSHKI DDS INC
Entity Type:Organization
Organization Name:MOEIZ KOSHKI DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:S
Authorized Official - Last Name:LEVIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-395-1261
Mailing Address - Street 1:1260 15TH ST STE 805
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-1143
Mailing Address - Country:US
Mailing Address - Phone:310-395-1261
Mailing Address - Fax:310-395-6645
Practice Address - Street 1:1260 15TH ST STE 805
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-1143
Practice Address - Country:US
Practice Address - Phone:310-395-1261
Practice Address - Fax:310-395-6645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-10
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty