Provider Demographics
NPI:1841852878
Name:ROBERT POUYA HEDVAT DDS, INC
Entity type:Organization
Organization Name:ROBERT POUYA HEDVAT DDS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:HEDVAT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:661-255-1211
Mailing Address - Street 1:23838 VALENCIA BLVD STE 301
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-5335
Mailing Address - Country:US
Mailing Address - Phone:661-255-2511
Mailing Address - Fax:661-255-1155
Practice Address - Street 1:23838 VALENCIA BLVD STE 301
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-5335
Practice Address - Country:US
Practice Address - Phone:661-255-2511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-29
Last Update Date:2024-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty