Healthcare Provider Details

I. General information

NPI: 1841601689
Provider Name (Legal Business Name): PLEASANT VALLEY FAMILYDENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2014
Last Update Date: 05/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4938 S C ST
OXNARD CA
93033-7504
US

IV. Provider business mailing address

4938 S C ST
OXNARD CA
93033-7504
US

V. Phone/Fax

Practice location:
  • Phone: 805-483-0421
  • Fax:
Mailing address:
  • Phone: 805-483-0421
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number35918
License Number StateCA

VIII. Authorized Official

Name: DR. REZA KARIMI
Title or Position: DENTIST/OWNER
Credential: DDS
Phone: 805-483-0421