Provider Demographics
NPI:1003255571
Name:SEPIDEH NOROOZI D.D.S. INC
Entity type:Organization
Organization Name:SEPIDEH NOROOZI D.D.S. INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SEPIDEH
Authorized Official - Middle Name:
Authorized Official - Last Name:NOROOZI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:323-566-0581
Mailing Address - Street 1:3525 FIRESTONE BLVD
Mailing Address - Street 2:
Mailing Address - City:SOUTH GATE
Mailing Address - State:CA
Mailing Address - Zip Code:90280-3031
Mailing Address - Country:US
Mailing Address - Phone:310-566-0581
Mailing Address - Fax:323-566-8328
Practice Address - Street 1:3525 FIRESTONE BLVD
Practice Address - Street 2:
Practice Address - City:SOUTH GATE
Practice Address - State:CA
Practice Address - Zip Code:90280-3031
Practice Address - Country:US
Practice Address - Phone:310-566-0581
Practice Address - Fax:323-566-8328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-18
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38946122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty