Provider Demographics
NPI:1437299575
Name:HOSSEINI, BABAK (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:BABAK
Middle Name:
Last Name:HOSSEINI
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 F ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-2845
Mailing Address - Country:US
Mailing Address - Phone:619-427-5262
Mailing Address - Fax:
Practice Address - Street 1:230 F ST
Practice Address - Street 2:SUITE D
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-2845
Practice Address - Country:US
Practice Address - Phone:619-427-5262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA426621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice