| Organization Name: | BEHZAD SHIRAZI ARDESTANI INC A PROFESSIONAL DENTAL CORPORATION |
| NPI Number: | 1003082074 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | BEHZAD SHIRAZI ARDESTANI (OWNER) |
| Mailing Address: | 500 E Olive Ave 430 Burbank |
| State: | CA US |
| Postal Code: | 915013316 |
| Phone Number: | 8185674662 |
| Fax Number: | 8185670554 |
| NPI Enumeration Date: | 04/30/2008 |
| NPI Last Update Date: | 04/07/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |