Provider Demographics
NPI:1669505475
Name:ABAZARI, LEYLA (DDS PED DENTISTRY)
Entity Type:Individual
Prefix:DR
First Name:LEYLA
Middle Name:
Last Name:ABAZARI
Suffix:
Gender:F
Credentials:DDS PED DENTISTRY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2663 ROSS RD
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94303-3640
Mailing Address - Country:US
Mailing Address - Phone:949-929-3781
Mailing Address - Fax:
Practice Address - Street 1:2663 ROSS RD
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94303-3640
Practice Address - Country:US
Practice Address - Phone:949-929-3781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA534361223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD53436Medicaid