Provider Demographics
NPI:1760935977
Name:RUBEN SHAHBAZIAN, DDS, PC
Entity Type:Organization
Organization Name:RUBEN SHAHBAZIAN, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RUBEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAHBAZIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:916-683-1994
Mailing Address - Street 1:7119 ELK GROVE BLVD STE 137
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-9568
Mailing Address - Country:US
Mailing Address - Phone:916-683-1994
Mailing Address - Fax:
Practice Address - Street 1:7119 ELK GROVE BLVD STE 137
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-9568
Practice Address - Country:US
Practice Address - Phone:916-683-1994
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-25
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty