Provider Demographics
NPI:1992077721
Name:ALIREZA MOVASSAGHI, D.D.S, INC.
Entity type:Organization
Organization Name:ALIREZA MOVASSAGHI, D.D.S, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALIREZA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOVASSAGHI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-327-4166
Mailing Address - Street 1:17305 CRENSHAW BLVD. STE. A
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90504
Mailing Address - Country:US
Mailing Address - Phone:310-327-4166
Mailing Address - Fax:310-327-4675
Practice Address - Street 1:17305 CRENSHAW BLVD STE A
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90504-2641
Practice Address - Country:US
Practice Address - Phone:310-327-4166
Practice Address - Fax:310-327-4675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-09
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39189122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty