Provider Demographics
NPI:1104276765
Name:JAVDAN, BEHDAD (DDS)
Entity type:Individual
Prefix:
First Name:BEHDAD
Middle Name:
Last Name:JAVDAN
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 1:5009 BREMNER WAY
Mailing Address - Street 2:APT #2
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95841-4622
Mailing Address - Country:US
Mailing Address - Phone:310-403-3479
Mailing Address - Fax:
Practice Address - Street 1:5009 BREMNER WAY
Practice Address - Street 2:APT #2
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95841-4622
Practice Address - Country:US
Practice Address - Phone:310-403-3479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-15
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1002741223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics