Pourshirazi H Corporation

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

POURSHIRAZI H CORPORATION

Doing business as

Diamond Dental and Orthodontics

Practice address

31500 Grape St
Suite 8
Lake Elsinore, CA 92532-9702

Phone

(951) 471-1628

Fax

(951) 471-1638

NPI assigned

Mar 20, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Keely Anderson Greeno

Title

Office Coordinator

Phone

(951) 672-9457

Specialties & licenses 1

Addresses

Other names 1

• Diamond Dental and Orthodontics Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1332201600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1332201600000",
    "number": "1255606547",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31500 GRAPE ST",
            "address_2": "SUITE 8",
            "city": "LAKE ELSINORE",
            "state": "CA",
            "postal_code": "925329702",
            "telephone_number": "951-471-1628",
            "fax_number": "951-471-1638"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31500 GRAPE ST",
            "address_2": "SUITE 8",
            "city": "LAKE ELSINORE",
            "state": "CA",
            "postal_code": "925329702",
            "telephone_number": "951-471-1628",
            "fax_number": "951-471-1638"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POURSHIRAZI H CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-20",
        "last_updated": "2012-03-20",
        "status": "A",
        "authorized_official_last_name": "GREENO",
        "authorized_official_first_name": "KEELY",
        "authorized_official_middle_name": "ANDERSON",
        "authorized_official_title_or_position": "OFFICE COORDINATOR",
        "authorized_official_telephone_number": "951-672-9457"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Diamond Dental and Orthodontics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• General Practice Dentistry in Lake Elsinore, CA
• Providers in Lake Elsinore, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.