Provider Demographics
NPI:1316511553
Name:REZAIE GPRS DENTAL GROUP INC
Entity type:Organization
Organization Name:REZAIE GPRS DENTAL GROUP INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:SANAZ
Authorized Official - Middle Name:
Authorized Official - Last Name:REZAIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-667-6297
Mailing Address - Street 1:8936 GLENOAKS BLVD
Mailing Address - Street 2:STE B
Mailing Address - City:SUN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91352-1352
Mailing Address - Country:US
Mailing Address - Phone:214-493-1216
Mailing Address - Fax:
Practice Address - Street 1:8936 GLENOAKS BLVD
Practice Address - Street 2:STE B
Practice Address - City:SUN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91352-1352
Practice Address - Country:US
Practice Address - Phone:214-493-1216
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-13
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty