Provider Demographics
NPI:1881805844
Name:ALIREZAEI, RAMBOD ROBBY (DDS)
Entity type:Individual
Prefix:DR
First Name:RAMBOD
Middle Name:ROBBY
Last Name:ALIREZAEI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11633 SAN VICENTE BLVD
Mailing Address - Street 2:SUITE #308
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-6511
Mailing Address - Country:US
Mailing Address - Phone:310-207-3707
Mailing Address - Fax:310-207-3703
Practice Address - Street 1:11633 SAN VICENTE BLVD
Practice Address - Street 2:SUITE #308
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049-6511
Practice Address - Country:US
Practice Address - Phone:310-207-3707
Practice Address - Fax:310-207-3703
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA488721223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics