Provider Demographics
NPI:1013633494
Name:FIROUZEH MANESH JAVIDZAD, DDS, A PROFESSIONAL DENTAL CORPORATION
Entity Type:Organization
Organization Name:FIROUZEH MANESH JAVIDZAD, DDS, A PROFESSIONAL DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:FIROUZEH
Authorized Official - Middle Name:K MANESH
Authorized Official - Last Name:JAVIDZAD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-788-6684
Mailing Address - Street 1:15720 VENTURA BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2922
Mailing Address - Country:US
Mailing Address - Phone:818-788-6684
Mailing Address - Fax:
Practice Address - Street 1:15720 VENTURA BLVD STE 300
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2922
Practice Address - Country:US
Practice Address - Phone:818-788-6684
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-17
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental