Provider Demographics
NPI:1861591521
Name:HIRI ETESSAMI DDS, INC.
Entity type:Organization
Organization Name:HIRI ETESSAMI DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HIRBOD
Authorized Official - Middle Name:
Authorized Official - Last Name:ETESSAMI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-550-0506
Mailing Address - Street 1:9201 SUNSET BLVD
Mailing Address - Street 2:SUITE 908
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90069
Mailing Address - Country:US
Mailing Address - Phone:310-550-0506
Mailing Address - Fax:310-550-0613
Practice Address - Street 1:9201 SUNSET BLVD
Practice Address - Street 2:SUITE 908
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90069
Practice Address - Country:US
Practice Address - Phone:310-550-0506
Practice Address - Fax:310-550-0613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA373291223E0200X
CADC352091223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty