Provider Demographics
NPI:1821585803
Name:BEHNOUD REYHANI DENTAL CORP
Entity Type:Organization
Organization Name:BEHNOUD REYHANI DENTAL CORP
Other - Org Name:SOUTH GATE FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BEHNOUD
Authorized Official - Middle Name:
Authorized Official - Last Name:REYHANI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:562-925-3735
Mailing Address - Street 1:9426 SOMERSET BLVD
Mailing Address - Street 2:
Mailing Address - City:BELLFLOWER
Mailing Address - State:CA
Mailing Address - Zip Code:90706-3009
Mailing Address - Country:US
Mailing Address - Phone:562-925-3735
Mailing Address - Fax:562-381-9150
Practice Address - Street 1:2639 SANTA ANA ST
Practice Address - Street 2:
Practice Address - City:SOUTH GATE
Practice Address - State:CA
Practice Address - Zip Code:90280-2025
Practice Address - Country:US
Practice Address - Phone:323-583-1481
Practice Address - Fax:562-381-9150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-16
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental