Provider Demographics
NPI:1932703790
Name:DR AZADEH ABRAHAM DENTAL INC.
Entity Type:Organization
Organization Name:DR AZADEH ABRAHAM DENTAL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AZADEH
Authorized Official - Middle Name:
Authorized Official - Last Name:ABRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-846-3830
Mailing Address - Street 1:8131 ROSECRANS AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:PARAMOUNT
Mailing Address - State:CA
Mailing Address - Zip Code:90723-2758
Mailing Address - Country:US
Mailing Address - Phone:562-634-2984
Mailing Address - Fax:562-634-2986
Practice Address - Street 1:8131 ROSECRANS AVE STE 101
Practice Address - Street 2:
Practice Address - City:PARAMOUNT
Practice Address - State:CA
Practice Address - Zip Code:90723-2758
Practice Address - Country:US
Practice Address - Phone:562-634-2984
Practice Address - Fax:562-634-2986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-23
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental