Provider Demographics
NPI:1336300805
Name:ETEMAD, BABAK ROBERT (DMD)
Entity Type:Individual
Prefix:DR
First Name:BABAK
Middle Name:ROBERT
Last Name:ETEMAD
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 1:3472 FOREST HILL BLVD STE 2A
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33406-5864
Mailing Address - Country:US
Mailing Address - Phone:561-429-2196
Mailing Address - Fax:
Practice Address - Street 1:3472 FOREST HILL BLVD # 2
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33406-5864
Practice Address - Country:US
Practice Address - Phone:954-608-3818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-18
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN17996122300000X
CA590-28122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist