Provider Demographics
NPI:1831109644
Name:NEJATFARD DENTAL CORPORATION
Entity type:Organization
Organization Name:NEJATFARD DENTAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:HAMEED
Authorized Official - Middle Name:
Authorized Official - Last Name:NEJATFARD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-210-0515
Mailing Address - Street 1:6314 LAUREL CANYON BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91606-3213
Mailing Address - Country:US
Mailing Address - Phone:818-210-0515
Mailing Address - Fax:
Practice Address - Street 1:6314 LAUREL CANYON BLVD # 104
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606-3213
Practice Address - Country:US
Practice Address - Phone:818-210-0515
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45157122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty