Provider Demographics
NPI:1376988675
Name:BITA TAHVILDARI, D.D.S.
Entity Type:Organization
Organization Name:BITA TAHVILDARI, D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BITA
Authorized Official - Middle Name:
Authorized Official - Last Name:TAHVILDARI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:619-295-5261
Mailing Address - Street 1:3588 4TH AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-4981
Mailing Address - Country:US
Mailing Address - Phone:619-295-5261
Mailing Address - Fax:619-295-5706
Practice Address - Street 1:3588 4TH AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-4981
Practice Address - Country:US
Practice Address - Phone:619-295-5261
Practice Address - Fax:619-295-5706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-01
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40776122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty