Provider Demographics
NPI:1437234234
Name:SHAY S SALEHRABI DDS INC
Entity Type:Organization
Organization Name:SHAY S SALEHRABI DDS INC
Other - Org Name:DENTISTRY FOR CHILDREN & ADULTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAY
Authorized Official - Middle Name:S
Authorized Official - Last Name:SALEHRABI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-904-1444
Mailing Address - Street 1:PO BOX 7917
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91409
Mailing Address - Country:US
Mailing Address - Phone:818-904-1444
Mailing Address - Fax:818-904-1446
Practice Address - Street 1:16260 VENTURA BLVD
Practice Address - Street 2:SUITE 410
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2203
Practice Address - Country:US
Practice Address - Phone:818-904-1444
Practice Address - Fax:818-904-1446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA409821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB40982Medicaid