Provider Demographics
NPI:1447600523
Name:ALBAYATI, AVEN (DDS)
Entity Type:Individual
Prefix:
First Name:AVEN
Middle Name:
Last Name:ALBAYATI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1917 CORONA VIS
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92019-4262
Mailing Address - Country:US
Mailing Address - Phone:619-820-7743
Mailing Address - Fax:
Practice Address - Street 1:1917 CORONA VIS
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92019-4262
Practice Address - Country:US
Practice Address - Phone:619-820-7743
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-20
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100282122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist