Provider Demographics
NPI:1740667781
Name:TWO TREES DENTAL CENTER
Entity type:Organization
Organization Name:TWO TREES DENTAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HOMAYOUN
Authorized Official - Middle Name:H
Authorized Official - Last Name:ZADEH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, PHD
Authorized Official - Phone:818-703-7733
Mailing Address - Street 1:1601 EASTMAN AVE UNIT 105
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-6441
Mailing Address - Country:US
Mailing Address - Phone:805-658-0232
Mailing Address - Fax:
Practice Address - Street 1:1601 EASTMAN AVE UNIT 105
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-6441
Practice Address - Country:US
Practice Address - Phone:805-658-0232
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-29
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35503261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental