Provider Demographics
NPI:1922542356
Name:MALEKI & NOORI DENTAL PARTNERSHIP
Entity Type:Organization
Organization Name:MALEKI & NOORI DENTAL PARTNERSHIP
Other - Org Name:SOUTH GATE DENTISTRY & ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MEHRDAD
Authorized Official - Middle Name:
Authorized Official - Last Name:NOORI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:323-581-0754
Mailing Address - Street 1:8536 LONG BEACH BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:SOUTH GATE
Mailing Address - State:CA
Mailing Address - Zip Code:90280-2017
Mailing Address - Country:US
Mailing Address - Phone:323-581-0754
Mailing Address - Fax:323-581-2106
Practice Address - Street 1:8536 LONG BEACH BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:SOUTH GATE
Practice Address - State:CA
Practice Address - Zip Code:90280-2017
Practice Address - Country:US
Practice Address - Phone:323-581-0754
Practice Address - Fax:323-581-2106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-03
Last Update Date:2016-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57118122300000X
CA58117122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty