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General NPI Number Information
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NPI Number | 1619480183
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Entity Type | Organization
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Legal Business Name | SHAHAB EBRAHIMIAN DENTAL GROUP, INC.
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Dates
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Enumeration Date | 11/07/2017
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Last Update Date | 11/07/2017
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Provider Practice Location Address
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Address Line | 26560 AGOURA RD STE 102
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City | CALABASAS
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State | CA
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Zip | 91302-1949
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Country | US
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Telephone | 818-880-4023
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Fax |
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Provider Business Mailing Address
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Address Line | 13949 VENTURA BLVD STE 250
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City | SHERMAN OAKS
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State | CA
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Zip | 91423-5734
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Country | US
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Telephone | 818-387-6387
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Fax | 818-386-8375
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Authorized Official
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Title or Position | OWNER
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Name | SHAHAB EBRAHIMIAN
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Credential |
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Telephone | 818-387-6387
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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