Provider Demographics
NPI:1629376827
Name:PAYAM BARZIVAND, D.D.S., INC.
Entity Type:Organization
Organization Name:PAYAM BARZIVAND, D.D.S., INC.
Other - Org Name:AFFORDABLE GENTLE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAYAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BARZIVAND
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-782-5020
Mailing Address - Street 1:6600A VAN NUYS BLVD
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-4617
Mailing Address - Country:US
Mailing Address - Phone:818-782-5020
Mailing Address - Fax:818-782-2454
Practice Address - Street 1:6600A VAN NUYS BLVD
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-4617
Practice Address - Country:US
Practice Address - Phone:818-782-5020
Practice Address - Fax:818-782-2454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-11
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54590122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty