Provider Demographics
NPI:1639933948
Name:B IRAVANI DDS
Entity type:Organization
Organization Name:B IRAVANI DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTAL ANESTHESIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BOSHRA
Authorized Official - Middle Name:SOPHIA
Authorized Official - Last Name:IRAVANI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:240-751-3031
Mailing Address - Street 1:2880 W OLYMPIC BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-2644
Mailing Address - Country:US
Mailing Address - Phone:310-962-1119
Mailing Address - Fax:
Practice Address - Street 1:2880 W OLYMPIC BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-2644
Practice Address - Country:US
Practice Address - Phone:310-962-1119
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-07
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental