| Shahram Nouri Dental Corp. | |
|
5216 Laurel Canyon Blvd Valley Village CA 91607-2710 | |
| (818) 769-1347 | |
| (818) 769-3563 |
| Full Name | Shahram Nouri Dental Corp. |
|---|---|
| Speciality | Dentist |
| Location | 5216 Laurel Canyon Blvd, Valley Village, California |
| Authorized Official Name and Position | Shahram Nouri (DENTIST) |
| Authorized Official Contact | 8188855200 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Shahram Nouri Dental Corp. 9318 Reseda Blvd Northridge CA 91324-2926 Ph: (818) 885-5200 | Shahram Nouri Dental Corp. 5216 Laurel Canyon Blvd Valley Village CA 91607-2710 Ph: (818) 769-1347 |
| NPI Number | 1356844583 |
|---|---|
| Provider Enumeration Date | 03/14/2018 |
| Last Update Date | 03/14/2018 |
| Medicare PECOS PAC ID | 0648692772 |
|---|---|
| Medicare Enrollment ID | O20200618002621 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356844583 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 48974 (California) | Primary |
| Provider Name | Shahram Nouri |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1912069170 PECOS PAC ID: 2466874599 Enrollment ID: I20200618002667 |
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