Provider Demographics
NPI:1831661966
Name:DARAIE DENTAL GROUP INC
Entity Type:Organization
Organization Name:DARAIE DENTAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KAVEH TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:DARAIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-616-6816
Mailing Address - Street 1:5620 WILBUR AVENUE STE 300
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356
Mailing Address - Country:US
Mailing Address - Phone:310-616-6816
Mailing Address - Fax:818-708-1396
Practice Address - Street 1:5620 WILBUR AVENUE STE 300
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356
Practice Address - Country:US
Practice Address - Phone:310-616-6816
Practice Address - Fax:818-708-1396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-31
Last Update Date:2018-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty