Provider Demographics
NPI:1609076116
Name:PAYAM PEZESHKIAN D.D.S. INC.
Entity Type:Organization
Organization Name:PAYAM PEZESHKIAN D.D.S. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAYAM PEZESHKIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PEZESHKIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-351-7607
Mailing Address - Street 1:1161 HIDDEN VALLEY PKWY
Mailing Address - Street 2:SUITE 106
Mailing Address - City:NORCO
Mailing Address - State:CA
Mailing Address - Zip Code:92860-3916
Mailing Address - Country:US
Mailing Address - Phone:949-351-7607
Mailing Address - Fax:
Practice Address - Street 1:1161 HIDDEN VALLEY PKWY
Practice Address - Street 2:SUITE 106
Practice Address - City:NORCO
Practice Address - State:CA
Practice Address - Zip Code:92860-3916
Practice Address - Country:US
Practice Address - Phone:949-351-7607
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51987122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty