Provider Demographics
NPI:1144695362
Name:PAUL BABAKHANOF, D.D.S. INCORPORATED
Entity type:Organization
Organization Name:PAUL BABAKHANOF, D.D.S. INCORPORATED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:BABAKHANOF
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:661-418-2390
Mailing Address - Street 1:2809 W AVENUE L
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93536-4021
Mailing Address - Country:US
Mailing Address - Phone:661-418-2390
Mailing Address - Fax:661-998-8037
Practice Address - Street 1:2809 W AVENUE L
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93536-4021
Practice Address - Country:US
Practice Address - Phone:661-418-2390
Practice Address - Fax:661-998-8037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-14
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54585122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty