Provider Demographics
NPI:1811211022
Name:NATALIE KHADAVI, DDS, INC
Entity Type:Organization
Organization Name:NATALIE KHADAVI, DDS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:DEBORAH
Authorized Official - Last Name:KHADAVI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-427-8585
Mailing Address - Street 1:12331 1/4 W WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-5509
Mailing Address - Country:US
Mailing Address - Phone:310-482-3971
Mailing Address - Fax:
Practice Address - Street 1:12331 1/4 W WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-5509
Practice Address - Country:US
Practice Address - Phone:310-482-3971
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-16
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57048122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty