Provider Demographics
NPI:1639869993
Name:SHAHINIAN AND NOVSHADIAN DENTAL GROUP
Entity Type:Organization
Organization Name:SHAHINIAN AND NOVSHADIAN DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAHINIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:323-825-8558
Mailing Address - Street 1:3342 VERDUGO RD STE B
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90065-2845
Mailing Address - Country:US
Mailing Address - Phone:323-825-8558
Mailing Address - Fax:
Practice Address - Street 1:3342 VERDUGO RD STE B
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90065-2845
Practice Address - Country:US
Practice Address - Phone:323-825-8558
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-10
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA103248OtherDENTAL LICENSE