Provider Demographics
NPI:1679631873
Name:HOMEIRA FIROOZEH& MAHVASH EMAMISADR INC
Entity Type:Organization
Organization Name:HOMEIRA FIROOZEH& MAHVASH EMAMISADR INC
Other - Org Name:LYONS DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAHVASH
Authorized Official - Middle Name:
Authorized Official - Last Name:EMAMISADR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:661-255-1015
Mailing Address - Street 1:24036 LYONS AVE
Mailing Address - Street 2:
Mailing Address - City:NEWHALL
Mailing Address - State:CA
Mailing Address - Zip Code:91321
Mailing Address - Country:US
Mailing Address - Phone:661-255-1015
Mailing Address - Fax:661-255-2812
Practice Address - Street 1:24036 LYONS AVE
Practice Address - Street 2:
Practice Address - City:NEWHALL
Practice Address - State:CA
Practice Address - Zip Code:91321
Practice Address - Country:US
Practice Address - Phone:661-255-1015
Practice Address - Fax:661-255-2812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38049122300000X
CA38679122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty