Provider Demographics
NPI:1508114125
Name:MENALAGHA, NARGES (DDS)
Entity Type:Individual
Prefix:
First Name:NARGES
Middle Name:
Last Name:MENALAGHA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6345 BALBOA BLVD
Mailing Address - Street 2:#314, BUILDING #1
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-1519
Mailing Address - Country:US
Mailing Address - Phone:818-600-8667
Mailing Address - Fax:
Practice Address - Street 1:6345 BALBOA BLVD
Practice Address - Street 2:#314, BUILDING #1
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-1519
Practice Address - Country:US
Practice Address - Phone:818-600-8667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-29
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA614561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1508114125OtherDENTI-CAL