Provider Demographics
NPI:1639215536
Name:H. REZA SHAHMOHAMADI DENTAL CORPORATION
Entity Type:Organization
Organization Name:H. REZA SHAHMOHAMADI DENTAL CORPORATION
Other - Org Name:HAMLIN DENTAL GRP
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DENTIST (OWNER)
Authorized Official - Prefix:
Authorized Official - First Name:SHAHMOHAMMADI
Authorized Official - Middle Name:HAMID
Authorized Official - Last Name:REZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-285-5757
Mailing Address - Street 1:12509 OXNARD ST
Mailing Address - Street 2:201
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91606
Mailing Address - Country:US
Mailing Address - Phone:818-285-5757
Mailing Address - Fax:818-285-5760
Practice Address - Street 1:12509 OXNARD ST
Practice Address - Street 2:201
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606
Practice Address - Country:US
Practice Address - Phone:818-285-5757
Practice Address - Fax:818-285-5760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty