Provider Demographics
NPI:1013158617
Name:JADID MONTAZERI D.D.S. DENTAL, CORP.
Entity Type:Organization
Organization Name:JADID MONTAZERI D.D.S. DENTAL, CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MEHRNOOSH
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTAZERI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:323-888-0999
Mailing Address - Street 1:1332 W WHITTIER BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-4601
Mailing Address - Country:US
Mailing Address - Phone:323-888-0999
Mailing Address - Fax:818-541-1688
Practice Address - Street 1:1332 W WHITTIER BLVD
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-4601
Practice Address - Country:US
Practice Address - Phone:323-888-0999
Practice Address - Fax:818-541-1688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-12
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49549122300000X
CA511111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty