Provider Demographics
NPI:1396260972
Name:BARKHORDAR DENTAL INC
Entity type:Organization
Organization Name:BARKHORDAR DENTAL INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OMID
Authorized Official - Middle Name:R
Authorized Official - Last Name:BARKHORDAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:424-277-1138
Mailing Address - Street 1:310 E GRAND AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:EL SEGUNDO
Mailing Address - State:CA
Mailing Address - Zip Code:90245-3871
Mailing Address - Country:US
Mailing Address - Phone:424-277-1138
Mailing Address - Fax:
Practice Address - Street 1:310 E GRAND AVE STE 102
Practice Address - Street 2:
Practice Address - City:EL SEGUNDO
Practice Address - State:CA
Practice Address - Zip Code:90245-3871
Practice Address - Country:US
Practice Address - Phone:424-277-1138
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OMID RABI BARHORDAR
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-08-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1538607965OtherNPI
CA1821229444OtherNPI