Provider Demographics
NPI:1245454008
Name:MONEMPOUR, FRED (DDS)
Entity type:Individual
Prefix:DR
First Name:FRED
Middle Name:
Last Name:MONEMPOUR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:FARBOD
Other - Middle Name:
Other - Last Name:MONEMPOUR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:435 N BEDFORD DR
Mailing Address - Street 2:SUITE 416
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4321
Mailing Address - Country:US
Mailing Address - Phone:310-278-5993
Mailing Address - Fax:310-278-4817
Practice Address - Street 1:435 N BEDFORD DR
Practice Address - Street 2:SUITE 416
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4321
Practice Address - Country:US
Practice Address - Phone:310-278-5993
Practice Address - Fax:310-278-4817
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA462991223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics