Provider Demographics
NPI:1578396503
Name:PEYKAR DENTAL CORPORATION
Entity type:Organization
Organization Name:PEYKAR DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OMID
Authorized Official - Middle Name:
Authorized Official - Last Name:PEYKAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-349-1980
Mailing Address - Street 1:12820 INGLEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-5118
Mailing Address - Country:US
Mailing Address - Phone:310-349-1980
Mailing Address - Fax:310-349-1984
Practice Address - Street 1:12820 INGLEWOOD AVE
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-5118
Practice Address - Country:US
Practice Address - Phone:310-349-1980
Practice Address - Fax:310-349-1984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-23
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty