Provider Demographics
NPI:1093777617
Name:LADAN NADDAFI DDS INC
Entity Type:Organization
Organization Name:LADAN NADDAFI DDS INC
Other - Org Name:CONEJO SMILE DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LADAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NADDAFI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:805-557-0909
Mailing Address - Street 1:498 VIA COLINAS
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91362
Mailing Address - Country:US
Mailing Address - Phone:805-370-8043
Mailing Address - Fax:805-370-3299
Practice Address - Street 1:1736 N MOORPARK RD
Practice Address - Street 2:SUITE H
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360
Practice Address - Country:US
Practice Address - Phone:805-557-0909
Practice Address - Fax:805-557-0908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-06
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48340122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA48340OtherCA DENTAL BOARD
CAG9307601OtherDENTI-CAL