Provider Demographics
NPI:1841355633
Name:SHABTAIE, RAMIN (DDS)
Entity type:Individual
Prefix:DR
First Name:RAMIN
Middle Name:
Last Name:SHABTAIE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:10921 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 608
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-3906
Mailing Address - Country:US
Mailing Address - Phone:310-208-3471
Mailing Address - Fax:310-208-2553
Practice Address - Street 1:10921 WILSHIRE BLVD
Practice Address - Street 2:SUITE 608
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-3906
Practice Address - Country:US
Practice Address - Phone:310-208-3471
Practice Address - Fax:310-208-2553
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA435611223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery