Provider Demographics
NPI:1659808624
Name:KABIRI PREMIER DENTAL INC.
Entity Type:Organization
Organization Name:KABIRI PREMIER DENTAL INC.
Other - Org Name:KABIRI PREMIER DENTAL INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AZITA
Authorized Official - Middle Name:
Authorized Official - Last Name:KABIRI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:925-206-0735
Mailing Address - Street 1:4284 DIAVILA AVE
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-8373
Mailing Address - Country:US
Mailing Address - Phone:925-206-0735
Mailing Address - Fax:510-878-2690
Practice Address - Street 1:425 ESTUDILLO AVE STE B
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-4906
Practice Address - Country:US
Practice Address - Phone:510-969-8510
Practice Address - Fax:510-878-2690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-22
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100543122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1053867622Medicaid