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General NPI Number Information
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NPI Number | 1528789161
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Entity Type | Organization
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Legal Business Name | BABAK JAVIDI DMD INC
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Dates
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Enumeration Date | 09/12/2022
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Last Update Date | 09/12/2022
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Provider Practice Location Address
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Address Line | 12125 ALTA CARMEL CT STE 310
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City | SAN DIEGO
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State | CA
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Zip | 92128-3892
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Country | US
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Telephone | 619-800-4948
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Fax |
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Provider Business Mailing Address
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Address Line | 12125 ALTA CARMEL CT STE 310
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City | SAN DIEGO
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State | CA
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Zip | 92128-3892
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Country | US
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Telephone | 619-800-4948
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Fax |
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Authorized Official
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Title or Position | OWNER DENTIST
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Name | DR. BABAK JAVIDI
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Credential | DMD
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Telephone | 857-230-8493
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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