Provider Demographics
NPI:1861746653
Name:PEGGY NAJMABADI, D.D.S., A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:PEGGY NAJMABADI, D.D.S., A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:
Authorized Official - Last Name:NAJMABADI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-246-0059
Mailing Address - Street 1:606 E GLENOAKS BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91207-1779
Mailing Address - Country:US
Mailing Address - Phone:818-246-0059
Mailing Address - Fax:818-246-0245
Practice Address - Street 1:606 E GLENOAKS BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91207-1779
Practice Address - Country:US
Practice Address - Phone:818-246-0059
Practice Address - Fax:818-246-0245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-01
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB41962-01OtherDENTI-CAL