Provider Demographics
NPI:1841846433
Name:P.SIONAT DENTAL CORP.
Entity type:Organization
Organization Name:P.SIONAT DENTAL CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:PAYAM
Authorized Official - Last Name:SIONAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-709-1045
Mailing Address - Street 1:10910 SANTA MONICA BLVD APT 3C
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-4512
Mailing Address - Country:US
Mailing Address - Phone:310-709-1045
Mailing Address - Fax:
Practice Address - Street 1:1800 W 6TH ST STE 2
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-3139
Practice Address - Country:US
Practice Address - Phone:310-709-1045
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-10
Last Update Date:2019-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental