Provider Demographics
NPI:1780871350
Name:KHODADADI, RAMIN N (DDS)
Entity type:Individual
Prefix:DR
First Name:RAMIN
Middle Name:N
Last Name:KHODADADI
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 1:227 W JANSS RD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-1848
Mailing Address - Country:US
Mailing Address - Phone:805-495-5990
Mailing Address - Fax:805-495-5994
Practice Address - Street 1:227 W JANSS RD
Practice Address - Street 2:SUITE 140
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-1848
Practice Address - Country:US
Practice Address - Phone:805-495-5990
Practice Address - Fax:805-495-5994
Is Sole Proprietor?:No
Enumeration Date:2007-09-27
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA473781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice