Healthcare Provider Details

I. General information

NPI: 1427700947
Provider Name (Legal Business Name): ABNER MAHBOOBIAN DENTAL PARTNERSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2022
Last Update Date: 01/25/2022
Certification Date: 01/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 SAN FERNANDO RD
SAN FERNANDO CA
91340-3374
US

IV. Provider business mailing address

800 SAN FERNANDO RD
SAN FERNANDO CA
91340-3374
US

V. Phone/Fax

Practice location:
  • Phone: 818-898-1818
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. OMEED MAHBOOBIAN
Title or Position: PARTNER
Credential: DDS
Phone: 310-435-5115