Provider Demographics
NPI:1891816807
Name:KEN N HABASHY DDSINC
Entity Type:Organization
Organization Name:KEN N HABASHY DDSINC
Other - Org Name:SANTA MARIA DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNERDENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KEN
Authorized Official - Middle Name:NADER
Authorized Official - Last Name:HABASHY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-365-1245
Mailing Address - Street 1:1230 SAN FERNANDO RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:SAN FERNANDO
Mailing Address - State:CA
Mailing Address - Zip Code:91340-3238
Mailing Address - Country:US
Mailing Address - Phone:818-365-1245
Mailing Address - Fax:818-365-7905
Practice Address - Street 1:1230 SAN FERNANDO RD
Practice Address - Street 2:SUITE B
Practice Address - City:SAN FERNANDO
Practice Address - State:CA
Practice Address - Zip Code:91340-3238
Practice Address - Country:US
Practice Address - Phone:818-365-1245
Practice Address - Fax:818-365-7905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35470122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty