Provider Demographics
NPI:1891812012
Name:BANKI, FIROUZEH (DMD)
Entity Type:Individual
Prefix:MS
First Name:FIROUZEH
Middle Name:
Last Name:BANKI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16633 VENTURA BLVD
Mailing Address - Street 2:SUITE 850
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-1801
Mailing Address - Country:US
Mailing Address - Phone:818-990-5900
Mailing Address - Fax:818-990-5907
Practice Address - Street 1:16633 VENTURA BLVD
Practice Address - Street 2:SUITE 850
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-1801
Practice Address - Country:US
Practice Address - Phone:818-990-5900
Practice Address - Fax:818-990-5907
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA446531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD44653OtherDENTI-CAL LICENSE NUMBER