MEDICARE: DR. RUBEN SHAHBAZIAN D.D.S

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	1223G0001X	General Practice Dentistry	43396	CA

General Provider Information

NPI Number	:	1942419056
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RUBEN SHAHBAZIAN D.D.S

Provider Business Mailing Address
First Line	:	4501 BLOSSOM RANCH DR
Second Line	:
City	:	ELK GROVE
State	:	CA
Zip	:	95757-3270
Country	:	US
Telephone Number	:	916-683-1994
Fax Number	:

Provider Business Practice Location Address
First Line	:	7119 ELK GROVE BLVD STE 137
Second Line	:
City	:	ELK GROVE
State	:	CA
Zip	:	95758-9568
Country	:	US
Telephone Number	:	916-683-1994
Fax Number	:

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

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	11/17/2016

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