Provider Demographics
NPI:1548582026
Name:MASTOUR, PEDRAM S (DDS)
Entity Type:Individual
Prefix:DR
First Name:PEDRAM
Middle Name:S
Last Name:MASTOUR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:PEDRAM
Other - Middle Name:E
Other - Last Name:MASTOUR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:5620 SAWTELLE BLVD
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-5508
Mailing Address - Country:US
Mailing Address - Phone:310-390-6212
Mailing Address - Fax:310-390-6215
Practice Address - Street 1:5620 SAWTELLE BLVD
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-5508
Practice Address - Country:US
Practice Address - Phone:310-390-6212
Practice Address - Fax:310-390-6215
Is Sole Proprietor?:No
Enumeration Date:2010-02-24
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47525122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist