Provider Demographics
NPI:1376764001
Name:GHAVIBONIHE, ALI (DDS)
Entity Type:Individual
Prefix:
First Name:ALI
Middle Name:
Last Name:GHAVIBONIHE
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 1:4535 SAN FELICIANO DR
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-5037
Mailing Address - Country:US
Mailing Address - Phone:818-517-6330
Mailing Address - Fax:
Practice Address - Street 1:1835 S LA CIENEGA BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-4600
Practice Address - Country:US
Practice Address - Phone:310-836-0300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49754122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist