Provider Demographics
NPI:1932324399
Name:PALMDENTAL
Entity Type:Organization
Organization Name:PALMDENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARYAM
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMEZANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-846-7008
Mailing Address - Street 1:411 E PALM AVE
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91501-2010
Mailing Address - Country:US
Mailing Address - Phone:818-846-3738
Mailing Address - Fax:818-846-3738
Practice Address - Street 1:411 E PALM AVE
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91501-2010
Practice Address - Country:US
Practice Address - Phone:818-846-3738
Practice Address - Fax:818-846-3738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty