Provider Demographics
NPI:1578321469
Name:KHORSANDI, OLIVER (DDS)
Entity Type:Individual
Prefix:DR
First Name:OLIVER
Middle Name:
Last Name:KHORSANDI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:619 N HILLCREST RD
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-3514
Mailing Address - Country:US
Mailing Address - Phone:310-601-6898
Mailing Address - Fax:
Practice Address - Street 1:755 W RANCHO VISTA BLVD
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-3735
Practice Address - Country:US
Practice Address - Phone:661-265-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-06
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS1097661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice