Provider Demographics
NPI:1104118520
Name:MONSEF, PEYMAN (DDS)
Entity type:Individual
Prefix:
First Name:PEYMAN
Middle Name:
Last Name:MONSEF
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 1:1037 E PALMDALE BLVD STE 203
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93550-4745
Mailing Address - Country:US
Mailing Address - Phone:661-272-9181
Mailing Address - Fax:661-272-8932
Practice Address - Street 1:1037 E PALMDALE BLVD STE 203
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93550
Practice Address - Country:US
Practice Address - Phone:661-272-9181
Practice Address - Fax:661-272-8932
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-03
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA601541223G0001X
TX278431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice