Provider Demographics
NPI:1528504222
Name:AHDOOT DENTISTRY, INC.
Entity type:Organization
Organization Name:AHDOOT DENTISTRY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDMOND
Authorized Official - Middle Name:REUBEN
Authorized Official - Last Name:AHDOOT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-883-2173
Mailing Address - Street 1:6342 FALLBROOK AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-1613
Mailing Address - Country:US
Mailing Address - Phone:818-883-2173
Mailing Address - Fax:
Practice Address - Street 1:6342 FALLBROOK AVE STE 202
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-1613
Practice Address - Country:US
Practice Address - Phone:818-883-2173
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-18
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA611631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty