Provider Demographics
NPI:1801597018
Name:BABAK ABRISHAMI DENTAL CORP
Entity type:Organization
Organization Name:BABAK ABRISHAMI DENTAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BABAK
Authorized Official - Middle Name:
Authorized Official - Last Name:ABRISHAMI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-435-5537
Mailing Address - Street 1:11743 KIOWA AVE APT 202
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-6135
Mailing Address - Country:US
Mailing Address - Phone:310-435-5537
Mailing Address - Fax:
Practice Address - Street 1:3808 W RIVERSIDE DR STE 508
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-5301
Practice Address - Country:US
Practice Address - Phone:747-245-3527
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-14
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental