Healthcare Provider Details

I. General information

NPI: 1396326153
Provider Name (Legal Business Name): P SHAHBAZIAN DDS CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2021
Last Update Date: 04/15/2021
Certification Date: 04/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2885 TAPO ST
SIMI VALLEY CA
93063-1728
US

IV. Provider business mailing address

2900 CORDA LN
LOS ANGELES CA
90049-1105
US

V. Phone/Fax

Practice location:
  • Phone: 805-527-5772
  • Fax:
Mailing address:
  • Phone: 310-280-8234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: PIROUZ SHAHBAZIAN
Title or Position: PRESIDENT
Credential:
Phone: 310-280-8234