Provider Demographics
NPI:1689450140
Name:ASSAL ABDOSSALEHI DDS INC
Entity Type:Organization
Organization Name:ASSAL ABDOSSALEHI DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ASSAL
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDOSSALEHI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-477-7729
Mailing Address - Street 1:4700 D ST STE D
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90712-2500
Mailing Address - Country:US
Mailing Address - Phone:617-477-7729
Mailing Address - Fax:
Practice Address - Street 1:4700 D ST STE D
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90712-2500
Practice Address - Country:US
Practice Address - Phone:617-477-7729
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-31
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty