Provider Demographics
NPI:1629822051
Name:ALIREZAEI AND JABAITI DENTAL CORPORATION
Entity Type:Organization
Organization Name:ALIREZAEI AND JABAITI DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KOUROSH
Authorized Official - Middle Name:
Authorized Official - Last Name:KEIHANI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-562-2046
Mailing Address - Street 1:1901 SOLAR DR STE 250
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93036-0661
Mailing Address - Country:US
Mailing Address - Phone:805-853-3636
Mailing Address - Fax:
Practice Address - Street 1:1901 SOLAR DR STE 250
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-0661
Practice Address - Country:US
Practice Address - Phone:805-853-3636
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-12
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty