MEDICARE: LADAN NADDAFI DDS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	48340	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	48340	OTHER	CA	CA DENTAL BOARD
2	G9307601	OTHER	CA	DENTI-CAL

General Provider Information

NPI Number	:	1093777617
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LADAN NADDAFI DDS INC

Provider Business Mailing Address
First Line	:	498 VIA COLINAS
Second Line	:
City	:	WESTLAKE VILLAGE
State	:	CA
Zip	:	91362
Country	:	US
Telephone Number	:	805-370-8043
Fax Number	:	805-370-3299

Provider Business Practice Location Address
First Line	:	1736 N MOORPARK RD
Second Line	:	SUITE H
City	:	THOUSAND OAKS
State	:	CA
Zip	:	91360
Country	:	US
Telephone Number	:	805-557-0909
Fax Number	:	805-557-0908

Authorized Official
Title or Position	:	PRESIDENT OWNER
Name	:	MRS. LADAN NADDAFI
Credential	:	DDS
Telephone Number	:	805-557-0909

Provider Enumeration Date	:	04/06/2006
Last Update Date	:	08/07/2014

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