Provider Demographics
NPI:1699184960
Name:TEBOUL AND ZARGARPOUR DENTAL CORPORATION
Entity Type:Organization
Organization Name:TEBOUL AND ZARGARPOUR DENTAL CORPORATION
Other - Org Name:TARZANA DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SIAVASH
Authorized Official - Middle Name:
Authorized Official - Last Name:ZARGARPOUR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-708-3232
Mailing Address - Street 1:18399 VENTURA BLVD
Mailing Address - Street 2:#234
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-4233
Mailing Address - Country:US
Mailing Address - Phone:818-708-3232
Mailing Address - Fax:818-708-7202
Practice Address - Street 1:18399 VENTURA BLVD
Practice Address - Street 2:#234
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-4233
Practice Address - Country:US
Practice Address - Phone:818-708-3232
Practice Address - Fax:818-708-7202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-12
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45072122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty