Provider Demographics
NPI:1063060895
Name:BABROOD DENTAL CORPORATION
Entity type:Organization
Organization Name:BABROOD DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARYET
Authorized Official - Middle Name:NIKKIE
Authorized Official - Last Name:BABROOD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-766-7776
Mailing Address - Street 1:12520 MAGNOLIA BLVD STE 205
Mailing Address - Street 2:
Mailing Address - City:VALLEY VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91607-2346
Mailing Address - Country:US
Mailing Address - Phone:818-766-7776
Mailing Address - Fax:818-760-3414
Practice Address - Street 1:12520 MAGNOLIA BLVD STE 205
Practice Address - Street 2:
Practice Address - City:VALLEY VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91607-2346
Practice Address - Country:US
Practice Address - Phone:818-766-7776
Practice Address - Fax:818-760-3414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-26
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA102559OtherDDS