Provider Demographics
NPI:1194381251
Name:BABAK SHAHROKH DMD INC
Entity Type:Organization
Organization Name:BABAK SHAHROKH DMD INC
Other - Org Name:SAN MARCOS DENTAL STUDIO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BABAK
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAHROKH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:760-471-9560
Mailing Address - Street 1:365 S RANCHO SANTA FE RD STE 105
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-2338
Mailing Address - Country:US
Mailing Address - Phone:760-471-9560
Mailing Address - Fax:760-471-9574
Practice Address - Street 1:955 BOARDWALK STE 204
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-2659
Practice Address - Country:US
Practice Address - Phone:760-471-9560
Practice Address - Fax:760-471-9574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-14
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty