Provider Demographics
NPI:1750767851
Name:TARABISHI DDS, INC
Entity type:Organization
Organization Name:TARABISHI DDS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:FARAH
Authorized Official - Middle Name:SAAD
Authorized Official - Last Name:TARABISHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-278-2700
Mailing Address - Street 1:4223 GENESEE AVE STE 109
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-4951
Mailing Address - Country:US
Mailing Address - Phone:858-278-2700
Mailing Address - Fax:
Practice Address - Street 1:4223 GENESEE AVE STE 109
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-4951
Practice Address - Country:US
Practice Address - Phone:858-278-2700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-31
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40890122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty