Provider Demographics
NPI:1982200259
Name:SHAHRIYAR E BARADARAN DDS MS A PROF CORP
Entity Type:Organization
Organization Name:SHAHRIYAR E BARADARAN DDS MS A PROF CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAHRIYAR
Authorized Official - Middle Name:
Authorized Official - Last Name:BARADARAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:310-526-1560
Mailing Address - Street 1:414 N CAMDEN DR STE 1240
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4512
Mailing Address - Country:US
Mailing Address - Phone:310-526-1560
Mailing Address - Fax:
Practice Address - Street 1:414 N CAMDEN DR STE 1240
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4512
Practice Address - Country:US
Practice Address - Phone:310-526-1560
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-10
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty