Provider Demographics
NPI:1689839409
Name:RAZMAZMA, BABAK (DDS)
Entity Type:Individual
Prefix:DR
First Name:BABAK
Middle Name:
Last Name:RAZMAZMA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11654 PLAZA AMERICA DR # 163
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-4700
Mailing Address - Country:US
Mailing Address - Phone:818-822-2278
Mailing Address - Fax:
Practice Address - Street 1:11654 PLAZA AMERICA DR # 163
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-4700
Practice Address - Country:US
Practice Address - Phone:818-822-2278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-21
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57316122300000X, 1223D0004X
VA0401415377122300000X
VA04470000741223D0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0004XDental ProvidersDentistDentist Anesthesiologist
No122300000XDental ProvidersDentist