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General NPI Number Information
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NPI Number | 1356546550
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Entity Type | Organization
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Legal Business Name | DAVID SHABANZADEH D.D.S.,INC.
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Dates
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Enumeration Date | 06/18/2007
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Last Update Date | 02/17/2011
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Provider Practice Location Address
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Address Line | 326 N VERMONT AVE SUITE B
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City | LOS ANGELES
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State | CA
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Zip | 90004-3511
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Country | US
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Telephone | 323-661-2626
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Fax |
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Provider Business Mailing Address
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Address Line | 326 N VERMONT AVE SUITE B
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City | LOS ANGELES
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State | CA
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Zip | 90004-3511
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Country | US
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Telephone | 323-661-2626
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DAVID SHABANZADEH
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Credential | D.D.S.
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Telephone | 818-448-0676
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 40728
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License Number State | CA
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