Provider Demographics
NPI:1245777143
Name:RABIZADEH, MICHAEL OMID (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:OMID
Last Name:RABIZADEH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19409 STAGG ST
Mailing Address - Street 2:
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-2351
Mailing Address - Country:US
Mailing Address - Phone:818-723-4337
Mailing Address - Fax:
Practice Address - Street 1:19409 STAGG ST
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-2351
Practice Address - Country:US
Practice Address - Phone:818-723-4337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-30
Last Update Date:2021-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS1009861223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics