Provider Demographics
NPI:1699491340
Name:MICHAEL KHORSHIDI DDS A DENTAL CORPORATION
Entity type:Organization
Organization Name:MICHAEL KHORSHIDI DDS A DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:FARAZ
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:KHORSHIDI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:424-285-4043
Mailing Address - Street 1:9735 WILSHIRE BLVD STE 404
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-2103
Mailing Address - Country:US
Mailing Address - Phone:424-285-4043
Mailing Address - Fax:213-377-2424
Practice Address - Street 1:9735 WILSHIRE BLVD STE 404
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-2103
Practice Address - Country:US
Practice Address - Phone:424-285-4043
Practice Address - Fax:213-377-2424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-14
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental