Provider Demographics
NPI:1689971061
Name:PAYAM KHALEPARI D.M.D A PROFESSIONAL DENTAL CORPORATION
Entity Type:Organization
Organization Name:PAYAM KHALEPARI D.M.D A PROFESSIONAL DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAYAM
Authorized Official - Middle Name:
Authorized Official - Last Name:KHALEPARI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:818-231-9907
Mailing Address - Street 1:26787 AGOURA RD STE E5
Mailing Address - Street 2:
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91302-1960
Mailing Address - Country:US
Mailing Address - Phone:818-231-9907
Mailing Address - Fax:
Practice Address - Street 1:26787 AGOURA RD STE E5
Practice Address - Street 2:
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302-1960
Practice Address - Country:US
Practice Address - Phone:818-231-9907
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-21
Last Update Date:2011-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA537101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty