Provider Demographics
NPI:1255120275
Name:MOUSSAVIAN DDS INC
Entity type:Organization
Organization Name:MOUSSAVIAN DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PARISA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOUSSAVIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:805-666-0907
Mailing Address - Street 1:505 W BEVERLY BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-3621
Mailing Address - Country:US
Mailing Address - Phone:323-724-1330
Mailing Address - Fax:
Practice Address - Street 1:505 W BEVERLY BLVD
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-3621
Practice Address - Country:US
Practice Address - Phone:323-724-1330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-05
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental