Provider Demographics
NPI:1386600161
Name:ENTEZAM, MONA (DDS)
Entity type:Individual
Prefix:DR
First Name:MONA
Middle Name:
Last Name:ENTEZAM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7301 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE#305
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307-1904
Mailing Address - Country:US
Mailing Address - Phone:818-327-7172
Mailing Address - Fax:818-327-5695
Practice Address - Street 1:7301 MEDICAL CENTER DR
Practice Address - Street 2:SUITE#305
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307-1904
Practice Address - Country:US
Practice Address - Phone:818-327-7172
Practice Address - Fax:818-327-5695
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA443981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice