Provider Demographics
NPI:1619194966
Name:TURKZADEH, TANNAZ
Entity Type:Individual
Prefix:DR
First Name:TANNAZ
Middle Name:
Last Name:TURKZADEH
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:TANNAZ
Other - Middle Name:
Other - Last Name:GOODJOHN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:8733 BEVERLY BLVD #300
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048
Mailing Address - Country:US
Mailing Address - Phone:310-652-6518
Mailing Address - Fax:310-652-3796
Practice Address - Street 1:8733 BEVERLY BLVD #300
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048
Practice Address - Country:US
Practice Address - Phone:310-652-6518
Practice Address - Fax:310-652-3796
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA399051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice