Provider Demographics
NPI:1538472311
Name:SHAWN RABIZADEH DDS2, A PROFESSIONAL DENTAL CORP.
Entity type:Organization
Organization Name:SHAWN RABIZADEH DDS2, A PROFESSIONAL DENTAL CORP.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:RABIZADEH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:805-388-1048
Mailing Address - Street 1:2177 VENTURA BLVD
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-7934
Mailing Address - Country:US
Mailing Address - Phone:805-388-1048
Mailing Address - Fax:
Practice Address - Street 1:2177 VENTURA BLVD
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-7934
Practice Address - Country:US
Practice Address - Phone:805-388-1048
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-21
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46324122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty