Provider Demographics
NPI:1215626882
Name:DANESHGAR ORAL & MAXILLOFACIAL SURGERY, INC.
Entity type:Organization
Organization Name:DANESHGAR ORAL & MAXILLOFACIAL SURGERY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SHARIAR
Authorized Official - Middle Name:SHAUN
Authorized Official - Last Name:DANESHGAR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:323-653-9440
Mailing Address - Street 1:6360 WILSHIRE BOULEVARD
Mailing Address - Street 2:SUITE 403
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-5606
Mailing Address - Country:US
Mailing Address - Phone:323-653-9440
Mailing Address - Fax:323-653-3586
Practice Address - Street 1:6360 WILSHIRE BOULEVARD
Practice Address - Street 2:SUITE 403
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5606
Practice Address - Country:US
Practice Address - Phone:323-653-9440
Practice Address - Fax:323-653-3586
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DANESHGAR ORAL & MAXILLOFACIAL SURGERY, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty