Provider Demographics
NPI:1063760965
Name:EBRAHIMI, NINUS (DMD)
Entity type:Individual
Prefix:DR
First Name:NINUS
Middle Name:
Last Name:EBRAHIMI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23969 NEWHALL RANCH RD.
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1240 S WESTLAKE BLVD STE 127
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-1984
Practice Address - Country:US
Practice Address - Phone:805-409-9195
Practice Address - Fax:805-852-5250
Is Sole Proprietor?:No
Enumeration Date:2012-08-27
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA613741223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry