Provider Demographics
NPI:1275261257
Name:NINUS EBRAHIMI, DMD, A DENTAL CORPORATION
Entity Type:Organization
Organization Name:NINUS EBRAHIMI, DMD, A DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NINUS
Authorized Official - Middle Name:
Authorized Official - Last Name:EBRAHIMI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:805-409-9195
Mailing Address - Street 1:1240 S WESTLAKE BLVD STE 127
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-1984
Mailing Address - Country:US
Mailing Address - Phone:805-409-9195
Mailing Address - Fax:
Practice Address - Street 1:1240 S WESTLAKE BLVD STE 127
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-1984
Practice Address - Country:US
Practice Address - Phone:805-409-9195
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-09
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty