Provider Demographics
NPI:1508296435
Name:FEDER MASHKOURI DENTAL PARTNERSHIP
Entity Type:Organization
Organization Name:FEDER MASHKOURI DENTAL PARTNERSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NIMA
Authorized Official - Middle Name:
Authorized Official - Last Name:MASHKOURI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:310-458-8811
Mailing Address - Street 1:1304 15TH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-1809
Mailing Address - Country:US
Mailing Address - Phone:310-458-8811
Mailing Address - Fax:
Practice Address - Street 1:1304 15TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-1809
Practice Address - Country:US
Practice Address - Phone:310-458-8811
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-13
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA527561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty