Provider Demographics
NPI:1891337762
Name:EDA METHASANI DDS DENTAL CORP
Entity Type:Organization
Organization Name:EDA METHASANI DDS DENTAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOKIC
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-313-1063
Mailing Address - Street 1:4740 INGLEWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-5824
Mailing Address - Country:US
Mailing Address - Phone:310-313-1063
Mailing Address - Fax:310-398-5681
Practice Address - Street 1:4740 INGLEWOOD BLVD
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-5824
Practice Address - Country:US
Practice Address - Phone:310-313-1063
Practice Address - Fax:310-398-5681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-11
Last Update Date:2019-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty