Provider Demographics
NPI:1982918140
Name:ARIANNEJAD, BABAK (DMD)
Entity Type:Individual
Prefix:DR
First Name:BABAK
Middle Name:
Last Name:ARIANNEJAD
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6417 CAMINITO FORMBY
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-5811
Mailing Address - Country:US
Mailing Address - Phone:858-583-4627
Mailing Address - Fax:
Practice Address - Street 1:6417 CAMINITO FORMBY
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-5811
Practice Address - Country:US
Practice Address - Phone:858-583-4627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-29
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59452122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist