MEDICARE: BABAK JAVIDI DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry	106067	CA

General Provider Information

NPI Number	:	1407366727
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BABAK JAVIDI DMD

Provider Business Mailing Address
First Line	:	12125 ALTA CARMEL CT STE 310
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92128-3892
Country	:	US
Telephone Number	:	619-800-4948
Fax Number	:	619-800-4948

Provider Business Practice Location Address
First Line	:	12125 ALTA CARMEL CT STE 310
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92128-3892
Country	:	US
Telephone Number	:	619-800-4948
Fax Number	:	619-800-4948

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2017
Last Update Date	:	02/13/2024

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