Provider Demographics
NPI:1629312855
Name:REZA RAJABI DMD,INC.
Entity Type:Organization
Organization Name:REZA RAJABI DMD,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:REZA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAJABI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-360-0696
Mailing Address - Street 1:7776 LIMONITE AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92509-5314
Mailing Address - Country:US
Mailing Address - Phone:951-360-0696
Mailing Address - Fax:
Practice Address - Street 1:7776 LIMONITE AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92509-5314
Practice Address - Country:US
Practice Address - Phone:951-360-0696
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-09
Last Update Date:2012-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53266122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty