Provider Demographics
NPI:1770253767
Name:PM FAKHERI DENTAL CORP.
Entity Type:Organization
Organization Name:PM FAKHERI DENTAL CORP.
Other - Org Name:ACE DENTAL GROUP LONG BEACH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PEDRAM
Authorized Official - Middle Name:
Authorized Official - Last Name:FAKHERI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:562-253-0085
Mailing Address - Street 1:620 E SAN ANTONIO DR
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-2203
Mailing Address - Country:US
Mailing Address - Phone:562-253-0085
Mailing Address - Fax:562-966-6664
Practice Address - Street 1:620 E SAN ANTONIO DR
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-2203
Practice Address - Country:US
Practice Address - Phone:562-253-0085
Practice Address - Fax:562-966-6664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-20
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty