Provider Demographics
NPI:1639648413
Name:BABAK KHAYATAN DDS INC.
Entity Type:Organization
Organization Name:BABAK KHAYATAN DDS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BABAK
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAYATAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:925-778-1234
Mailing Address - Street 1:2734 DELTA FAIR BLVD
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94509-4100
Mailing Address - Country:US
Mailing Address - Phone:925-778-1234
Mailing Address - Fax:
Practice Address - Street 1:2734 DELTA FAIR BLVD
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-4100
Practice Address - Country:US
Practice Address - Phone:925-778-1234
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-21
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty