Provider Demographics
NPI:1689948531
Name:OSTADAGHAI, HAMID REZA (DDS)
Entity Type:Individual
Prefix:DR
First Name:HAMID
Middle Name:REZA
Last Name:OSTADAGHAI
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 1:1730 SEPULVEDA BLVD STE 1
Mailing Address - Street 2:#1
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501-6901
Mailing Address - Country:US
Mailing Address - Phone:310-325-8888
Mailing Address - Fax:310-325-3024
Practice Address - Street 1:1730 SEPULVEDA BLVD STE 1
Practice Address - Street 2:#1
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90501-6901
Practice Address - Country:US
Practice Address - Phone:310-325-8888
Practice Address - Fax:310-325-3024
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-23
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46316122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist