Healthcare Provider Details

I. General information

NPI: 1982918140
Provider Name (Legal Business Name): BABAK ARIANNEJAD DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2010
Last Update Date: 07/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6417 CAMINITO FORMBY
LA JOLLA CA
92037-5811
US

IV. Provider business mailing address

6417 CAMINITO FORMBY
LA JOLLA CA
92037-5811
US

V. Phone/Fax

Practice location:
  • Phone: 858-583-4627
  • Fax:
Mailing address:
  • Phone: 858-583-4627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number59452
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: