Provider Demographics
NPI:1851930655
Name:JABAITI DENTAL CORPORATION
Entity Type:Organization
Organization Name:JABAITI DENTAL CORPORATION
Other - Org Name:AVRA DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TARIQ
Authorized Official - Middle Name:
Authorized Official - Last Name:JABAITI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:805-941-1001
Mailing Address - Street 1:1708 S VICTORIA AVE STE B
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-6595
Mailing Address - Country:US
Mailing Address - Phone:805-941-1001
Mailing Address - Fax:
Practice Address - Street 1:1708 S VICTORIA AVE STE B
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-6595
Practice Address - Country:US
Practice Address - Phone:805-941-1001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-27
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental