Provider Demographics
NPI:1104951557
Name:MAHAL, BABAN (DDS)
Entity type:Individual
Prefix:DR
First Name:BABAN
Middle Name:
Last Name:MAHAL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:BABAN
Other - Middle Name:
Other - Last Name:DHARIWAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:6049 DOUGLAS BLVD STE 9
Mailing Address - Street 2:
Mailing Address - City:GRANITE BAY
Mailing Address - State:CA
Mailing Address - Zip Code:95746-6249
Mailing Address - Country:US
Mailing Address - Phone:916-800-5001
Mailing Address - Fax:916-791-1659
Practice Address - Street 1:6049 DOUGLAS BLVD STE 9
Practice Address - Street 2:
Practice Address - City:GRANITE BAY
Practice Address - State:CA
Practice Address - Zip Code:95746-6249
Practice Address - Country:US
Practice Address - Phone:916-800-5001
Practice Address - Fax:916-791-1659
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN166981223G0001X
CA642471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice