Provider Demographics
NPI:1184491706
Name:SKAFRI DENTAL PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:SKAFRI DENTAL PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KAFRI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-801-4479
Mailing Address - Street 1:2701 FIRESTONE BLVD STE G
Mailing Address - Street 2:
Mailing Address - City:SOUTH GATE
Mailing Address - State:CA
Mailing Address - Zip Code:90280-2778
Mailing Address - Country:US
Mailing Address - Phone:323-564-6906
Mailing Address - Fax:323-564-6908
Practice Address - Street 1:2701 FIRESTONE BLVD STE G
Practice Address - Street 2:
Practice Address - City:SOUTH GATE
Practice Address - State:CA
Practice Address - Zip Code:90280-2778
Practice Address - Country:US
Practice Address - Phone:323-564-6906
Practice Address - Fax:323-564-6908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental