Provider Demographics
NPI:1699234344
Name:BARZIVAND DENTAL CORPORATION
Entity type:Organization
Organization Name:BARZIVAND DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAYAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BARZIVAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-970-2528
Mailing Address - Street 1:121 S POINSETTIA PL
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-2803
Mailing Address - Country:US
Mailing Address - Phone:818-970-2528
Mailing Address - Fax:
Practice Address - Street 1:321 N LARCHMONT BLVD STE 722
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-6407
Practice Address - Country:US
Practice Address - Phone:323-466-8607
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-12
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental