Provider Demographics
NPI:1770147670
Name:LANGROODI DENTAL PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:LANGROODI DENTAL PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HOUMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LANGROODI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-993-2798
Mailing Address - Street 1:1250 S NIGHT STAR WAY
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92808-2518
Mailing Address - Country:US
Mailing Address - Phone:310-993-2798
Mailing Address - Fax:
Practice Address - Street 1:5461 HOLT BLVD
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:CA
Practice Address - Zip Code:91763-4500
Practice Address - Country:US
Practice Address - Phone:909-983-6888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-25
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty