Provider Demographics
NPI:1134478704
Name:HEDVAT, ROBERT POUYA (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:POUYA
Last Name:HEDVAT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:339 N. OAKHURST DR. #203
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210
Mailing Address - Country:US
Mailing Address - Phone:310-666-0711
Mailing Address - Fax:
Practice Address - Street 1:23838 VALENCIA BLVD STE 301
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-5335
Practice Address - Country:US
Practice Address - Phone:661-255-2511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-29
Last Update Date:2024-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61719122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist