Provider Demographics
NPI:1316683022
Name:NORWALK DENTAL OFFICE OF ALBORZ MEHDIZADEH INC
Entity type:Organization
Organization Name:NORWALK DENTAL OFFICE OF ALBORZ MEHDIZADEH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALBORZ
Authorized Official - Middle Name:
Authorized Official - Last Name:MEHDIZADEH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-913-8097
Mailing Address - Street 1:12100 IMPERIAL HWY # 101A
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650-3081
Mailing Address - Country:US
Mailing Address - Phone:562-210-8576
Mailing Address - Fax:562-210-8601
Practice Address - Street 1:12100 IMPERIAL HWY # 101A
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-3081
Practice Address - Country:US
Practice Address - Phone:562-210-8576
Practice Address - Fax:562-210-8601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-06
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental