| Mehrzad Firouzbakht Dental,inc | |
|
14100 Victory Blvd Van Nuys CA 91401-1958 | |
| (818) 908-9199 | |
| Not Available |
| Full Name | Mehrzad Firouzbakht Dental,inc |
|---|---|
| Speciality | Dentist |
| Location | 14100 Victory Blvd, Van Nuys, California |
| Authorized Official Name and Position | Mehrzad Firouzbakht (PRESIDENT) |
| Authorized Official Contact | 8189089199 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mehrzad Firouzbakht Dental,inc 14100 Victory Blvd Van Nuys CA 91401-1958 Ph: (818) 908-9199 | Mehrzad Firouzbakht Dental,inc 14100 Victory Blvd Van Nuys CA 91401-1958 Ph: (818) 908-9199 |
| NPI Number | 1235385113 |
|---|---|
| Provider Enumeration Date | 08/12/2008 |
| Last Update Date | 08/12/2008 |
| Medicare PECOS PAC ID | 0547692790 |
|---|---|
| Medicare Enrollment ID | O20191111000007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235385113 | NPI | - | NPPES |
| 1326221615 | Other | CA | DENTAL PROVIDER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 55616 (California) | Primary |
| Provider Name | Mehrzad Firouzbakht |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1326221615 PECOS PAC ID: 2365874518 Enrollment ID: I20191112000143 |
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