Provider Demographics
NPI:1447968540
Name:NIOSHA VAKILIAN DENTAL GROUP, INC
Entity type:Organization
Organization Name:NIOSHA VAKILIAN DENTAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NIOSHA
Authorized Official - Middle Name:
Authorized Official - Last Name:VAKILIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-876-2947
Mailing Address - Street 1:23333 CINEMA DR STE 190
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-5435
Mailing Address - Country:US
Mailing Address - Phone:661-254-9494
Mailing Address - Fax:661-254-9499
Practice Address - Street 1:23333 CINEMA DR STE 190
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-5435
Practice Address - Country:US
Practice Address - Phone:661-254-9494
Practice Address - Fax:661-254-9499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-08
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental