Provider Demographics
NPI:1770042616
Name:MONTEBELLO DENTAL ARTS DBA MONTEBELLO FAMILY DENTAL
Entity Type:Organization
Organization Name:MONTEBELLO DENTAL ARTS DBA MONTEBELLO FAMILY DENTAL
Other - Org Name:MONTEBELLO FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:VAHID
Authorized Official - Middle Name:
Authorized Official - Last Name:YAHOODAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-278-0170
Mailing Address - Street 1:711 W WHITTIER BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-4709
Mailing Address - Country:US
Mailing Address - Phone:323-278-0170
Mailing Address - Fax:323-278-1129
Practice Address - Street 1:711 W WHITTIER BLVD
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-4709
Practice Address - Country:US
Practice Address - Phone:323-278-0170
Practice Address - Fax:323-278-1129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-19
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental