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General NPI Number Information
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NPI Number | 1336300805
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Entity Type | Individual
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Provider Name | BABAK ROBERT ETEMAD DMD
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Gender | Male
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Dates
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Enumeration Date | 06/18/2008
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Last Update Date | 02/25/2021
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Provider Practice Location Address
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Address Line | 3472 FOREST HILL BLVD # 2
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City | WEST PALM BEACH
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State | FL
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Zip | 33406-5864
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Country | US
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Telephone | 954-608-3818
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Fax |
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Provider Business Mailing Address
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Address Line | 3472 FOREST HILL BLVD STE 2A
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City | WEST PALM BEACH
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State | FL
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Zip | 33406-5864
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Country | US
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Telephone | 561-429-2196
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | DN17996
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 590-28
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License Number State | CA
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