Provider Demographics
NPI:1811657539
Name:NABIZADEH DENTAL CORPORATION
Entity type:Organization
Organization Name:NABIZADEH DENTAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:NABIZADEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-435-7586
Mailing Address - Street 1:5143 CHIMENEAS AVE
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356
Mailing Address - Country:US
Mailing Address - Phone:818-676-0970
Mailing Address - Fax:818-676-0614
Practice Address - Street 1:7111 WINNETKA AVE SUITE #3
Practice Address - Street 2:
Practice Address - City:WINNETKA
Practice Address - State:CA
Practice Address - Zip Code:91306
Practice Address - Country:US
Practice Address - Phone:818-676-0970
Practice Address - Fax:818-676-0614
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NABIZADEH DENTAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-12-21
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty