Provider Demographics
NPI:1659858082
Name:BABROOD, MARYET NIKKIE (DDS)
Entity Type:Individual
Prefix:
First Name:MARYET
Middle Name:NIKKIE
Last Name:BABROOD
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 1:12955 RIVERSIDE DR APT 310
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423-2269
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12520 MAGNOLIA BLVD STE 205
Practice Address - Street 2:
Practice Address - City:VALLEY VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91607-2346
Practice Address - Country:US
Practice Address - Phone:818-766-7776
Practice Address - Fax:818-760-3414
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-27
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS1025591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA102559OtherDDS