| NPI | 1891110219 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BEHNAM BERNARD BASERI Owner 310-877-4767 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 62519) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: CA 62519) |
| 122300000X Dentist (Licence: CA 62519) | |
| 1223D0001X Dentist, Dental Public Health (Licence: CA 62519) | |
| 1223E0200X Dentist, Endodontics (Licence: CA 62519) | |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 62519) | |
| 1223P0300X Dentist, Periodontics (Licence: CA 62519) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 62519) | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CA 62519) | |
| 124Q00000X Dental Hygienist (Licence: CA 62519) | |
| Enumeration Date | 2014-02-21 |
| Last Update Date | 2015-05-04 |