Provider Demographics
NPI:1871917096
Name:NARGES MENALAGHA, D.D.S., A PROFESSIONAL DENTAL CORPORATION
Entity type:Organization
Organization Name:NARGES MENALAGHA, D.D.S., A PROFESSIONAL DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NARGES
Authorized Official - Middle Name:
Authorized Official - Last Name:MENALAGHA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-600-8667
Mailing Address - Street 1:6345 BALBOA BLVD STE 314
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-1500
Mailing Address - Country:US
Mailing Address - Phone:818-600-8667
Mailing Address - Fax:818-600-8668
Practice Address - Street 1:6345 BALBOA BLVD STE 314
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-1500
Practice Address - Country:US
Practice Address - Phone:818-600-8667
Practice Address - Fax:818-600-8668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-07
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61456122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty