Healthcare Provider Details

I. General information

NPI: 1639738149
Provider Name (Legal Business Name): DAVID A ABAZARI DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2019
Last Update Date: 10/14/2021
Certification Date: 10/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1704 MIRAMONTE AVE STE 91704
MOUNTAIN VIEW CA
94040-3766
US

IV. Provider business mailing address

34 FAENZA
NEWPORT COAST CA
92657-1601
US

V. Phone/Fax

Practice location:
  • Phone: 650-282-5758
  • Fax:
Mailing address:
  • Phone: 949-400-7991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number106533
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: