Provider Demographics
NPI:1710908660
Name:HABASHI, AFSHIN (DDS)
Entity Type:Individual
Prefix:
First Name:AFSHIN
Middle Name:
Last Name:HABASHI
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 1:7956 ENTRADA LAZANJA
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-3620
Mailing Address - Country:US
Mailing Address - Phone:702-338-3474
Mailing Address - Fax:
Practice Address - Street 1:10405 TIERRASANTA BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92124-2603
Practice Address - Country:US
Practice Address - Phone:858-492-9300
Practice Address - Fax:858-492-9332
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV32071223G0001X
CA437891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100506196Medicaid
NV1671512OtherUNITED CONCORDIA PROVIDER