Provider Demographics
NPI:1760813802
Name:101 DENTAL GROUP
Entity Type:Organization
Organization Name:101 DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:AMIR
Authorized Official - Middle Name:H
Authorized Official - Last Name:CHOROOMI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-735-3800
Mailing Address - Street 1:7259 OWENSMOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91303-1530
Mailing Address - Country:US
Mailing Address - Phone:818-999-9900
Mailing Address - Fax:818-999-9978
Practice Address - Street 1:7259 OWENSMOUTH AVE
Practice Address - Street 2:
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91303-1530
Practice Address - Country:US
Practice Address - Phone:818-999-9900
Practice Address - Fax:818-999-9978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-27
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA546341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty