Provider Demographics
NPI:1336327972
Name:FEIZBAKHSH DENTAL CORP
Entity Type:Organization
Organization Name:FEIZBAKHSH DENTAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:L
Authorized Official - Last Name:TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-207-1060
Mailing Address - Street 1:11628 SANTA MONICA BLVD
Mailing Address - Street 2:STE 101
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-2900
Mailing Address - Country:US
Mailing Address - Phone:310-207-1060
Mailing Address - Fax:310-207-6151
Practice Address - Street 1:11628 SANTA MONICA BLVD
Practice Address - Street 2:STE 101
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-2900
Practice Address - Country:US
Practice Address - Phone:310-207-1060
Practice Address - Fax:310-207-6151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-06
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA402381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty