Provider Demographics
NPI:1134308117
Name:BATNIJI, RAAED SAMIR (DMD)
Entity Type:Individual
Prefix:DR
First Name:RAAED
Middle Name:SAMIR
Last Name:BATNIJI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 GRAND AVE STE D
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-2230
Mailing Address - Country:US
Mailing Address - Phone:909-396-9944
Mailing Address - Fax:909-396-9984
Practice Address - Street 1:1111 GRAND AVE STE D
Practice Address - Street 2:
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-2230
Practice Address - Country:US
Practice Address - Phone:909-396-9944
Practice Address - Fax:909-396-9984
Is Sole Proprietor?:No
Enumeration Date:2007-10-26
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56383122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist