Provider Demographics
NPI:1619528064
Name:PESSAH DENTAL CORPORATION
Entity Type:Organization
Organization Name:PESSAH DENTAL CORPORATION
Other - Org Name:DOWNEY MODERN DENTISTRY DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GP/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ARIELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:PESSAH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:562-273-2050
Mailing Address - Street 1:PO BOX 920050
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75392-0050
Mailing Address - Country:US
Mailing Address - Phone:714-845-8500
Mailing Address - Fax:
Practice Address - Street 1:12214 LAKEWOOD BLVD STE 102
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90242-2663
Practice Address - Country:US
Practice Address - Phone:562-273-2050
Practice Address - Fax:562-247-9788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-26
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty