Provider Demographics
NPI:1104265958
Name:DESTINY DENTAL IMPLANT CENTER
Entity type:Organization
Organization Name:DESTINY DENTAL IMPLANT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ESFANDIAR
Authorized Official - Middle Name:
Authorized Official - Last Name:ABADI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:916-762-6377
Mailing Address - Street 1:6950 DESTINY DR
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95677-2987
Mailing Address - Country:US
Mailing Address - Phone:916-672-6377
Mailing Address - Fax:916-672-6477
Practice Address - Street 1:6950 DESTINY DR
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95677-2987
Practice Address - Country:US
Practice Address - Phone:916-672-6377
Practice Address - Fax:916-672-6477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-14
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51887261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental