Provider Demographics
NPI:1831356294
Name:TABESH, REZA (DDS)
Entity type:Individual
Prefix:DR
First Name:REZA
Middle Name:
Last Name:TABESH
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 1:1127 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 918
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-3901
Mailing Address - Country:US
Mailing Address - Phone:213-481-2917
Mailing Address - Fax:213-481-2922
Practice Address - Street 1:1127 WILSHIRE BLVD
Practice Address - Street 2:SUITE 918
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-3901
Practice Address - Country:US
Practice Address - Phone:213-481-2917
Practice Address - Fax:213-481-2922
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA379331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice