Provider Demographics
NPI:1649312018
Name:NOWFAR RAD, MADJID SR (DDS)
Entity type:Individual
Prefix:MR
First Name:MADJID
Middle Name:
Last Name:NOWFAR RAD
Suffix:SR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16260 VENTURA BLV
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436
Mailing Address - Country:US
Mailing Address - Phone:818-788-1334
Mailing Address - Fax:818-788-1335
Practice Address - Street 1:16260 VENTURA BLV
Practice Address - Street 2:SUITE 400
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436
Practice Address - Country:US
Practice Address - Phone:818-788-1334
Practice Address - Fax:818-788-1335
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA358231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice