Healthcare Provider Details

I. General information

NPI: 1235388778
Provider Name (Legal Business Name): AVO BABIAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2008
Last Update Date: 09/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38745 TIERRA SUBIDA AVE STE 160
PALMDALE CA
93551-4589
US

IV. Provider business mailing address

13843 MILBANK ST
SHERMAN OAKS CA
91423-2968
US

V. Phone/Fax

Practice location:
  • Phone: 661-272-9091
  • Fax:
Mailing address:
  • Phone: 818-425-7877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number52039
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: