Provider Demographics
NPI:1225860422
Name:PRECISION DENTAL & IMPLANT CENTER
Entity type:Organization
Organization Name:PRECISION DENTAL & IMPLANT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AHMAD REZA
Authorized Official - Middle Name:
Authorized Official - Last Name:EDALATI SHARBAF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-294-5214
Mailing Address - Street 1:3701 WILLIAMS BLVD STE 253
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065-3067
Mailing Address - Country:US
Mailing Address - Phone:504-469-1551
Mailing Address - Fax:504-469-1580
Practice Address - Street 1:3701 WILLIAMS BLVD STE 253
Practice Address - Street 2:
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065-3067
Practice Address - Country:US
Practice Address - Phone:504-469-1551
Practice Address - Fax:504-469-1580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-15
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental