Provider Demographics
NPI:1689261661
Name:KHADAVI DENTAL GROUP
Entity Type:Organization
Organization Name:KHADAVI DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KHADAVI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-427-8585
Mailing Address - Street 1:17709 SATICOY ST
Mailing Address - Street 2:
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-3350
Mailing Address - Country:US
Mailing Address - Phone:818-757-0017
Mailing Address - Fax:
Practice Address - Street 1:17709 SATICOY ST
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-3350
Practice Address - Country:US
Practice Address - Phone:818-757-0017
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-24
Last Update Date:2020-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental