Healthcare Provider Details

I. General information

NPI: 1629312855
Provider Name (Legal Business Name): REZA RAJABI DMD,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2012
Last Update Date: 11/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7776 LIMONITE AVE
RIVERSIDE CA
92509-5314
US

IV. Provider business mailing address

7776 LIMONITE AVE
RIVERSIDE CA
92509-5314
US

V. Phone/Fax

Practice location:
  • Phone: 951-360-0696
  • Fax:
Mailing address:
  • Phone: 951-360-0696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number53266
License Number StateCA

VIII. Authorized Official

Name: DR. REZA RAJABI
Title or Position: PRESIDENT
Credential:
Phone: 951-360-0696