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General NPI Number Information
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NPI Number | 1124248091
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Entity Type | Organization
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Legal Business Name | KAMBIZ MAHDAVI, DDS, A PROFESSIONAL DENTAL CORPORATION
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Dates
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Enumeration Date | 04/26/2007
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Last Update Date | 12/04/2012
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Provider Practice Location Address
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Address Line | 2875 E THOUSAND OAKS BLVD
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City | THOUSAND OAKS
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State | CA
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Zip | 91362-3202
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Country | US
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Telephone | 805-496-2200
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Fax | 805-496-2225
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Provider Business Mailing Address
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Address Line | 2875 E THOUSAND OAKS BLVD
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City | THOUSAND OAKS
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State | CA
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Zip | 91362-3202
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Country | US
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Telephone | 805-496-2200
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Fax | 805-496-2225
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KAMBIZ MAHDAVI
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Credential | DDS
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Telephone | 805-496-2200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 52639
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License Number State | CA
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