Provider Demographics
NPI:1346520053
Name:DAVOODIAN, BITA (DDS)
Entity Type:Individual
Prefix:DR
First Name:BITA
Middle Name:
Last Name:DAVOODIAN
Suffix:
Gender:F
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:PO BOX 146
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-0146
Mailing Address - Country:US
Mailing Address - Phone:310-372-6600
Mailing Address - Fax:
Practice Address - Street 1:1959 KINGSDALE AVE STE 202
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90278-3417
Practice Address - Country:US
Practice Address - Phone:310-793-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-25
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60768122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist