Provider Demographics
NPI:1700215514
Name:AIRPORT DENTAL CARE, PRACTICE OF DR. MOHAMMADI DDS, INC
Entity Type:Organization
Organization Name:AIRPORT DENTAL CARE, PRACTICE OF DR. MOHAMMADI DDS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:MEHDI
Authorized Official - Last Name:MOHAMMADI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:213-271-0390
Mailing Address - Street 1:1117 W MANCHESTER BLVD
Mailing Address - Street 2:UNIT O
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-1500
Mailing Address - Country:US
Mailing Address - Phone:213-271-0390
Mailing Address - Fax:
Practice Address - Street 1:1117 W MANCHESTER BLVD
Practice Address - Street 2:UNIT O
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-1500
Practice Address - Country:US
Practice Address - Phone:213-271-0390
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-02
Last Update Date:2013-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61402261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental