Provider Demographics
NPI:1902296395
Name:MIRMARASHI&MAKHMALBAFDENTAL CORPORATION
Entity Type:Organization
Organization Name:MIRMARASHI&MAKHMALBAFDENTAL CORPORATION
Other - Org Name:GLENDALE DENTAL ARTS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALI
Authorized Official - Middle Name:O
Authorized Official - Last Name:MAKHMALBAF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-241-1160
Mailing Address - Street 1:814 E BROADWAY STE 4
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-4554
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:814 E BROADWAY STE 4
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-4554
Practice Address - Country:US
Practice Address - Phone:818-241-1160
Practice Address - Fax:818-241-1320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-23
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty