Provider Demographics
NPI:1710656962
Name:AMIR DADGAR YEGANEH DDS MS INC
Entity Type:Organization
Organization Name:AMIR DADGAR YEGANEH DDS MS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD CERTIFIED ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:DADGAR-YEGANEH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:310-774-1372
Mailing Address - Street 1:1111 N. BRAND BLVD.
Mailing Address - Street 2:SUITE 201
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91202
Mailing Address - Country:US
Mailing Address - Phone:310-774-1372
Mailing Address - Fax:
Practice Address - Street 1:1111 N. BRAND BLVD.
Practice Address - Street 2:SUITE 201
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91202
Practice Address - Country:US
Practice Address - Phone:818-242-1173
Practice Address - Fax:818-242-1005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-10
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty