Provider Demographics
NPI:1396326153
Name:P SHAHBAZIAN DDS CORPORATION
Entity type:Organization
Organization Name:P SHAHBAZIAN DDS CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PIROUZ
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAHBAZIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-280-8234
Mailing Address - Street 1:2900 CORDA LN
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-1105
Mailing Address - Country:US
Mailing Address - Phone:310-280-8234
Mailing Address - Fax:
Practice Address - Street 1:2885 TAPO ST
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93063-1728
Practice Address - Country:US
Practice Address - Phone:805-527-5772
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-14
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental