Provider Demographics
NPI:1932319043
Name:MIKHAK, BABAK (DDS)
Entity Type:Individual
Prefix:DR
First Name:BABAK
Middle Name:
Last Name:MIKHAK
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 1:6650 RESEDA BLVD
Mailing Address - Street 2:SUITE # 101B
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-5340
Mailing Address - Country:US
Mailing Address - Phone:818-705-7645
Mailing Address - Fax:
Practice Address - Street 1:5312 COMERCIO LN STE B
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-2026
Practice Address - Country:US
Practice Address - Phone:310-920-9009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA530871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice