Provider Demographics
NPI:1477363463
Name:MEHDI MORADISERESHT, D.D.S., INC.
Entity type:Organization
Organization Name:MEHDI MORADISERESHT, D.D.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:MEHDI
Authorized Official - Middle Name:
Authorized Official - Last Name:MORADISERESHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-918-6595
Mailing Address - Street 1:20935 VANOWEN ST STE 207
Mailing Address - Street 2:
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91303-3806
Mailing Address - Country:US
Mailing Address - Phone:818-918-6595
Mailing Address - Fax:
Practice Address - Street 1:20935 VANOWEN ST STE 207
Practice Address - Street 2:
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91303-3806
Practice Address - Country:US
Practice Address - Phone:818-918-6595
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-10
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty