Provider Demographics
NPI:1053669101
Name:TABIBI DENTAL CORPORATION
Entity Type:Organization
Organization Name:TABIBI DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FARIBA
Authorized Official - Middle Name:
Authorized Official - Last Name:TABIBI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-895-0133
Mailing Address - Street 1:16002 HAWTHORNE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAWNDALE
Mailing Address - State:CA
Mailing Address - Zip Code:90260
Mailing Address - Country:US
Mailing Address - Phone:310-895-0133
Mailing Address - Fax:310-472-1427
Practice Address - Street 1:16002 HAWTHORNE BLVD
Practice Address - Street 2:
Practice Address - City:LAWNDALE
Practice Address - State:CA
Practice Address - Zip Code:90260-2646
Practice Address - Country:US
Practice Address - Phone:310-895-0133
Practice Address - Fax:310-472-1427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-21
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA411331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty