Provider Demographics
NPI:1548635444
Name:DESIGN DENTAL SPA
Entity type:Organization
Organization Name:DESIGN DENTAL SPA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAMIN
Authorized Official - Middle Name:D
Authorized Official - Last Name:PARTOVY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-822-3833
Mailing Address - Street 1:3206 WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-5553
Mailing Address - Country:US
Mailing Address - Phone:310-822-3833
Mailing Address - Fax:310-822-9623
Practice Address - Street 1:3206 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-5553
Practice Address - Country:US
Practice Address - Phone:310-822-3833
Practice Address - Fax:310-822-9623
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-03
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37892122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty