Provider Demographics
NPI:1447527569
Name:EDALATPAJOUH, FARAMARZ (DMD)
Entity type:Individual
Prefix:
First Name:FARAMARZ
Middle Name:
Last Name:EDALATPAJOUH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8704 WEST PICO BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035
Mailing Address - Country:US
Mailing Address - Phone:310-666-2385
Mailing Address - Fax:310-854-0505
Practice Address - Street 1:8704 WEST PICO BLVD
Practice Address - Street 2:
Practice Address - City:LOSANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035
Practice Address - Country:US
Practice Address - Phone:310-854-6565
Practice Address - Fax:310-854-0505
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-17
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40811122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist