Healthcare Provider Details

I. General information

NPI: 1912694928
Provider Name (Legal Business Name): ANAHITA TAJBAKHSH DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2023
Last Update Date: 04/20/2023
Certification Date: 04/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4233 COLDWATER CANYON AVE
STUDIO CITY CA
91604-1934
US

IV. Provider business mailing address

4233 COLDWATER CANYON AVE
STUDIO CITY CA
91604-1934
US

V. Phone/Fax

Practice location:
  • Phone: 818-980-3333
  • Fax:
Mailing address:
  • Phone: 818-980-3333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: ANAHITA TAJBAKHSH
Title or Position: PRACTICE OWNER
Credential:
Phone: 818-980-3333