Provider Demographics
NPI:1861932998
Name:MAKHMALBAF & MIRMARASHI DENTAL PARTNERSHIP
Entity type:Organization
Organization Name:MAKHMALBAF & MIRMARASHI DENTAL PARTNERSHIP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALI
Authorized Official - Middle Name:O
Authorized Official - Last Name:MAKHMALBAF
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-443-3030
Mailing Address - Street 1:10921 WILSHIRE BLVD STE 501
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-4001
Mailing Address - Country:US
Mailing Address - Phone:310-443-3030
Mailing Address - Fax:310-443-5660
Practice Address - Street 1:10921 WILSHIRE BLVD STE 501
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-4001
Practice Address - Country:US
Practice Address - Phone:310-443-3030
Practice Address - Fax:310-443-5660
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MIRMARSHI & MAKMALBAF DENTAL PARTNERSHIP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-03-08
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59489261Q00000X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA59489Medicaid