| NPI | 1568710333 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PEDRAM E. MASTOUR Dentist 310-390-6212 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics |
| 305R00000X Preferred Provider Organization | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery | |
| Enumeration Date | 2012-08-27 |
| Last Update Date | 2022-07-21 |