Provider Demographics
NPI:1407366727
Name:JAVIDI, BABAK (DMD)
Entity Type:Individual
Prefix:
First Name:BABAK
Middle Name:
Last Name:JAVIDI
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 1:12125 ALTA CARMEL CT STE 310
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-3892
Mailing Address - Country:US
Mailing Address - Phone:619-800-4948
Mailing Address - Fax:619-800-4948
Practice Address - Street 1:12125 ALTA CARMEL CT STE 310
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-3892
Practice Address - Country:US
Practice Address - Phone:619-800-4948
Practice Address - Fax:619-800-4948
Is Sole Proprietor?:No
Enumeration Date:2017-10-02
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1060671223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry