Provider Demographics
NPI:1255735163
Name:AMIR H. JAMSHEED, PROFESSIONAL DENTAL CORP.
Entity type:Organization
Organization Name:AMIR H. JAMSHEED, PROFESSIONAL DENTAL CORP.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMSHEED
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-501-0427
Mailing Address - Street 1:16055 VENTURA BLVD STE 1126
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2612
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16055 VENTURA BLVD STE 400
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2608
Practice Address - Country:US
Practice Address - Phone:818-501-0427
Practice Address - Fax:318-501-0583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-21
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA545131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty