Provider Demographics
NPI:1700239225
Name:GHAVIBONIHE DENTAL INC
Entity Type:Organization
Organization Name:GHAVIBONIHE DENTAL INC
Other - Org Name:EASY DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:GHAVIBONIHE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:805-485-8587
Mailing Address - Street 1:2660 E VINEYARD AVE
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93036-1615
Mailing Address - Country:US
Mailing Address - Phone:805-485-8587
Mailing Address - Fax:
Practice Address - Street 1:2660 E VINEYARD AVE
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-1615
Practice Address - Country:US
Practice Address - Phone:805-485-8587
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-20
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49754122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1376764001OtherDDS