Provider Demographics
NPI:1508583659
Name:EBI NIKJOO DENTAL CORP
Entity Type:Organization
Organization Name:EBI NIKJOO DENTAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:EBI
Authorized Official - Middle Name:D
Authorized Official - Last Name:NIKJOO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-348-8713
Mailing Address - Street 1:22114 ROSCOE BLVD
Mailing Address - Street 2:
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91304-3838
Mailing Address - Country:US
Mailing Address - Phone:818-348-8713
Mailing Address - Fax:
Practice Address - Street 1:22114 ROSCOE BLVD
Practice Address - Street 2:
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91304-3838
Practice Address - Country:US
Practice Address - Phone:818-348-8713
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-20
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental