Provider Demographics
NPI:1932353885
Name:MOHAMMAD VAFADAR DDS.INC
Entity Type:Organization
Organization Name:MOHAMMAD VAFADAR DDS.INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:VAFADAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-907-5900
Mailing Address - Street 1:15030 VENTURA BLVD STE 9
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-2444
Mailing Address - Country:US
Mailing Address - Phone:818-907-5900
Mailing Address - Fax:818-907-5903
Practice Address - Street 1:15030 VENTURA BLVD STE 9
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-2444
Practice Address - Country:US
Practice Address - Phone:818-907-5900
Practice Address - Fax:818-907-5903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-05
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA472011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty