Provider Demographics
NPI:1679014237
Name:SHERMAN WAY ORTHODONTICS
Entity Type:Organization
Organization Name:SHERMAN WAY ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ROUZBEH
Authorized Official - Middle Name:
Authorized Official - Last Name:VOSSOUGHI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-806-1599
Mailing Address - Street 1:18305 SHERMAN WAY # 5
Mailing Address - Street 2:
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-4425
Mailing Address - Country:US
Mailing Address - Phone:310-806-1599
Mailing Address - Fax:
Practice Address - Street 1:18305 SHERMAN WAY # 5
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-4425
Practice Address - Country:US
Practice Address - Phone:310-806-1599
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-16
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56913261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental