Provider Demographics
NPI:1063752079
Name:SAMAN EDALAT DDS INC.
Entity type:Organization
Organization Name:SAMAN EDALAT DDS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:EDALAT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-999-9669
Mailing Address - Street 1:13431 TELEGRAPH RD
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90605
Mailing Address - Country:US
Mailing Address - Phone:562-946-2838
Mailing Address - Fax:562-946-5939
Practice Address - Street 1:13431 TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90605-3435
Practice Address - Country:US
Practice Address - Phone:562-946-2838
Practice Address - Fax:562-946-5939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-28
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55962122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty