Provider Demographics
NPI:1689853582
Name:DR. NADER TABIBZADEH DDS DENTAL CORPORATION
Entity Type:Organization
Organization Name:DR. NADER TABIBZADEH DDS DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NADER
Authorized Official - Middle Name:
Authorized Official - Last Name:TABIBZADEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-723-4000
Mailing Address - Street 1:5460 DELLWOOD WAY
Mailing Address - Street 2:STE 30
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95118
Mailing Address - Country:US
Mailing Address - Phone:408-723-4000
Mailing Address - Fax:408-723-4013
Practice Address - Street 1:5460 DELLWOOD WAY
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95118
Practice Address - Country:US
Practice Address - Phone:408-723-4000
Practice Address - Fax:408-723-4013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-26
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA416811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty