Provider Demographics
NPI:1023474103
Name:COMPLETE DENTAL CARE DENTAL GROUP, OFFICE OF DARIEN EPHRAM D.D.S.
Entity type:Organization
Organization Name:COMPLETE DENTAL CARE DENTAL GROUP, OFFICE OF DARIEN EPHRAM D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DARIEN
Authorized Official - Middle Name:
Authorized Official - Last Name:EPHRAM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-422-2802
Mailing Address - Street 1:13402 HAWTHORNE BLVD
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-5806
Mailing Address - Country:US
Mailing Address - Phone:310-675-3030
Mailing Address - Fax:301-676-1154
Practice Address - Street 1:13402 HAWTHORNE BLVD
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-5806
Practice Address - Country:US
Practice Address - Phone:310-675-3030
Practice Address - Fax:301-676-1154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-06
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA608621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty