Provider Demographics
NPI:1497955363
Name:LILI MIRTORABI, D.D.S., A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:LILI MIRTORABI, D.D.S., A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LILI
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRTORABI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-589-3438
Mailing Address - Street 1:2030 N TUSTIN AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-7827
Mailing Address - Country:US
Mailing Address - Phone:714-547-6019
Mailing Address - Fax:714-547-3152
Practice Address - Street 1:2030 N TUSTIN AVE
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-7827
Practice Address - Country:US
Practice Address - Phone:714-547-6019
Practice Address - Fax:714-547-3152
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LILI MIRTORABIDDSMS A PROFESSIONAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty