Provider Demographics
NPI:1881134005
Name:BABAK RAZMAZMA DDS INC
Entity type:Organization
Organization Name:BABAK RAZMAZMA DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BABAK
Authorized Official - Middle Name:
Authorized Official - Last Name:RAZMAZMA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-822-2278
Mailing Address - Street 1:11654 PLAZA AMERICA DR
Mailing Address - Street 2:163
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-4700
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11654 PLAZA AMERICA DR
Practice Address - Street 2:163
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-4700
Practice Address - Country:US
Practice Address - Phone:818-822-2278
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-07
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN10016881223D0004X
VA04014153771223D0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0004XDental ProvidersDentistDental AnesthesiologyGroup - Single Specialty