Provider Demographics
NPI:1689832677
Name:RASTEGAR PANAH, ARASH (DDS)
Entity Type:Individual
Prefix:DR
First Name:ARASH
Middle Name:
Last Name:RASTEGAR PANAH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 NORTH AVIATION BLVD
Mailing Address - Street 2:UNIT A
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266
Mailing Address - Country:US
Mailing Address - Phone:310-937-6453
Mailing Address - Fax:310-937-6024
Practice Address - Street 1:200 NORTH AVIATION BLVD
Practice Address - Street 2:UNIT A
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266
Practice Address - Country:US
Practice Address - Phone:310-937-6453
Practice Address - Fax:310-937-6024
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-28
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48000122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist