NPIMap

Organization Active NPI

Mastour & Fard Dental Corp

Doing business as Community Dental Group, Inc.

  • Preferred Provider Organization
  • Newberry Park, CA
National Provider Identifier
1548730450
Registry record updated Oct 23, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Preferred Provider OrganizationTaxonomy code 305R00000X
Legal business name
MASTOUR & FARD DENTAL CORP
Doing business as
Community Dental Group, Inc.
Practice address
587 N. Ventu Park Road.
Suite C
Newberry Park, CA 91320
Phone
(805) 499-1253
Fax
(805) 499-1453
NPI assigned
Dec 4, 2018
Last updated
Oct 23, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 23, 2019

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

Authorized official

Name
Pedram Mastour, DDSNPI 1548582026
Title
Owner
Phone
(310) 804-0414

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Preferred Provider Organization 305R00000X NU Primary

Addresses

Primary practice location

587 N. Ventu Park Road.
Suite C
Newberry Park, CA 91320

Mailing address

5620 Sawtelle Blvd
Culver City, CA 90230-5508
Phone (310) 390-6212

Other names 1

  • Community Dental Group, Inc. Doing business as

National Provider Directory

National Provider Directory

Locations

5620 Sawtelle Blvd
Culver City, CA 90230
Phone (310) 390-6212

587 N Ventu Park Rd
Ste C
Newbury Park, CA 91320
Phone (805) 499-1253

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1543881600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1571788800000",
    "number": "1548730450",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5620 SAWTELLE BLVD",
            "city": "CULVER CITY",
            "state": "CA",
            "postal_code": "902305508",
            "telephone_number": "310-390-6212",
            "fax_number": "310-390-6215"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "587 N. VENTU PARK ROAD.",
            "address_2": "SUITE C",
            "city": "NEWBERRY PARK",
            "state": "CA",
            "postal_code": "91320",
            "telephone_number": "805-499-1253",
            "fax_number": "805-499-1453"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MASTOUR & FARD DENTAL CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-12-04",
        "last_updated": "2019-10-23",
        "status": "A",
        "authorized_official_last_name": "MASTOUR",
        "authorized_official_first_name": "PEDRAM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "310-804-0414",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Community Dental Group, Inc.",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Community Dental Group, Inc.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Newberry Park, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2019; 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.