Provider Demographics
NPI:1780803825
Name:M HAGHIGHATPOUR, DDS, INC
Entity type:Organization
Organization Name:M HAGHIGHATPOUR, DDS, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHSEN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAGHIGHATPOUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD, DDS
Authorized Official - Phone:310-856-6574
Mailing Address - Street 1:13624 HAWTHORNE BLVD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250
Mailing Address - Country:US
Mailing Address - Phone:310-856-6574
Mailing Address - Fax:310-856-6578
Practice Address - Street 1:13624 HAWTHORNE BLVD
Practice Address - Street 2:SUITE 205
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250
Practice Address - Country:US
Practice Address - Phone:310-856-6574
Practice Address - Fax:310-856-6578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA 49327122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty