Provider Demographics
NPI:1477932465
Name:RABIZADEH DDS APDC
Entity type:Organization
Organization Name:RABIZADEH DDS APDC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:RABIZADEH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-370-6466
Mailing Address - Street 1:6131 ORANGETHORPE AVE
Mailing Address - Street 2:SUITE #405
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90620-1315
Mailing Address - Country:US
Mailing Address - Phone:714-670-7134
Mailing Address - Fax:
Practice Address - Street 1:6131 ORANGETHORPE AVE
Practice Address - Street 2:SUITE #405
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90620-1315
Practice Address - Country:US
Practice Address - Phone:714-670-7134
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-22
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46324122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty