Provider Demographics
NPI:1902672777
Name:RADMANESH DENTAL PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:RADMANESH DENTAL PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PARHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:RADMANESH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-858-3305
Mailing Address - Street 1:148 N GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91791-1728
Mailing Address - Country:US
Mailing Address - Phone:626-858-3305
Mailing Address - Fax:
Practice Address - Street 1:148 N GRAND AVE
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91791-1728
Practice Address - Country:US
Practice Address - Phone:626-858-3305
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RADMANESH DENTAL PROFESSIONAL ORGANIZATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-12-01
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental