Provider Demographics
NPI:1265623847
Name:EBRAHIMIAN, MAX (DDS)
Entity type:Individual
Prefix:DR
First Name:MAX
Middle Name:
Last Name:EBRAHIMIAN
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 1:4738 SCOTTS VALLEY DR
Mailing Address - Street 2:SUITE A & B
Mailing Address - City:SCOTTS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95066-4239
Mailing Address - Country:US
Mailing Address - Phone:831-438-1322
Mailing Address - Fax:831-438-7046
Practice Address - Street 1:4738 SCOTTS VALLEY DR
Practice Address - Street 2:SUITE A & B
Practice Address - City:SCOTTS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95066-4239
Practice Address - Country:US
Practice Address - Phone:831-438-1322
Practice Address - Fax:831-438-7046
Is Sole Proprietor?:No
Enumeration Date:2007-08-07
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA285421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice