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General NPI Number Information
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NPI Number | 1740898048
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Entity Type | Organization
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Legal Business Name | PACIFIC DENTAL INC
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Dates
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Enumeration Date | 07/22/2020
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Last Update Date | 07/22/2020
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Provider Practice Location Address
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Address Line | 75 LONG CT
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City | THOUSAND OAKS
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State | CA
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Zip | 91360-6039
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Country | US
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Telephone | 805-496-8887
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Fax | 805-494-0677
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Provider Business Mailing Address
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Address Line | 75 LONG CT
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City | THOUSAND OAKS
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State | CA
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Zip | 91360-6039
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Country | US
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Telephone | 805-496-8887
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Fax | 805-494-0677
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Authorized Official
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Title or Position | OWNER
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Name | HAMID BABAEIAN
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Credential | CDT
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Telephone | 818-203-7000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 292200000X
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Taxonomy Name | Dental Laboratory
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License Number |
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License Number State |
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