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General NPI Number Information
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NPI Number | 1245176239
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Entity Type | Organization
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Legal Business Name | VAKILIAN-BAK DENTAL CORPORATION
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Dates
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Enumeration Date | 04/24/2026
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Last Update Date | 04/24/2026
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Provider Practice Location Address
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Address Line | 115 JENSEN CT STE 100
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City | THOUSAND OAKS
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State | CA
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Zip | 91360-7406
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Country | US
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Telephone | 805-497-2222
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Fax |
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Provider Business Mailing Address
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Address Line | 115 JENSEN CT STE 100
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City | THOUSAND OAKS
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State | CA
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Zip | 91360-7406
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. POUYA VAKILIAN
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Credential | DMD,MD
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Telephone | 858-652-9521
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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