Provider Demographics
NPI:1043764913
Name:HEMMAT & ROBOUBI DDS INC.
Entity Type:Organization
Organization Name:HEMMAT & ROBOUBI DDS INC.
Other - Org Name:ROBOUBI DDS.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MOJDEH
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBOUBI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:714-244-7244
Mailing Address - Street 1:34 NATURE
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92620-3828
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1799 N WATERMAN AVE
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-5107
Practice Address - Country:US
Practice Address - Phone:714-244-7244
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-09
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63504122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty