Provider Demographics
NPI:1861890451
Name:R. SALMASSIAN DDS INC
Entity type:Organization
Organization Name:R. SALMASSIAN DDS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:AMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:JANNATI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-578-8665
Mailing Address - Street 1:18607 VENTURA BOULEVARD
Mailing Address - Street 2:SUITE 209
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356
Mailing Address - Country:US
Mailing Address - Phone:818-578-8665
Mailing Address - Fax:818-578-8684
Practice Address - Street 1:18607 VENTURA BLVD
Practice Address - Street 2:SUITE 209
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-4159
Practice Address - Country:US
Practice Address - Phone:818-578-8665
Practice Address - Fax:818-578-8684
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-12
Last Update Date:2014-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62971122300000X
CA59605122300000X
CA61819122300000X
122300000X
CA563851223E0200X
CA515181223X0400X
CA532441223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty