Provider Demographics
NPI:1104607456
Name:ANGELICA CHAGHOURI DDS A PROFESSIONAL DENTAL CORPORATION
Entity type:Organization
Organization Name:ANGELICA CHAGHOURI DDS A PROFESSIONAL DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELICA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAGHOURI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-623-2226
Mailing Address - Street 1:2665 34TH ST
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-3114
Mailing Address - Country:US
Mailing Address - Phone:310-623-2226
Mailing Address - Fax:
Practice Address - Street 1:20301 VENTURA BLVD STE 220
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-0931
Practice Address - Country:US
Practice Address - Phone:310-623-2226
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-12
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty