Provider Demographics
NPI:1568674596
Name:SHAHRAM AMERIPOUR & RAMIN SHENEVAD A DENTAL CORP
Entity Type:Organization
Organization Name:SHAHRAM AMERIPOUR & RAMIN SHENEVAD A DENTAL CORP
Other - Org Name:SANTA MONICA DENTAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAHRAM
Authorized Official - Middle Name:
Authorized Official - Last Name:AMERIPOUR
Authorized Official - Suffix:SR
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-444-1818
Mailing Address - Street 1:11775 SANTA MONICA BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-2843
Mailing Address - Country:US
Mailing Address - Phone:310-444-1818
Mailing Address - Fax:310-444-3196
Practice Address - Street 1:11775 SANTA MONICA BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-2843
Practice Address - Country:US
Practice Address - Phone:310-444-1818
Practice Address - Fax:310-444-3196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48377261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental