Provider Demographics
NPI:1790827103
Name:SHIFTEH, BABAK (DDS)
Entity Type:Individual
Prefix:MR
First Name:BABAK
Middle Name:
Last Name:SHIFTEH
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 1:5828 TOPEKA DR
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-1318
Mailing Address - Country:US
Mailing Address - Phone:818-996-9389
Mailing Address - Fax:
Practice Address - Street 1:9700 WOODMAN AVE
Practice Address - Street 2:SUITE A28
Practice Address - City:ARLETA
Practice Address - State:CA
Practice Address - Zip Code:91331
Practice Address - Country:US
Practice Address - Phone:818-899-9999
Practice Address - Fax:818-897-6030
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA520271223G0001X
NY0477101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice