Provider Demographics
NPI:1821390030
Name:TARABISHI DDS INC.
Entity Type:Organization
Organization Name:TARABISHI DDS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:TARABISHI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:858-278-2700
Mailing Address - Street 1:6465 BALABOA AVE SUIT B
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111
Mailing Address - Country:US
Mailing Address - Phone:858-278-2700
Mailing Address - Fax:858-278-2789
Practice Address - Street 1:6465 BALBOA AVE STE B
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-3155
Practice Address - Country:US
Practice Address - Phone:858-278-2700
Practice Address - Fax:858-278-2789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-19
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40890122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
B4089001OtherNATIONAL PROVIDER IDENTIFICATION NUMBER