Provider Demographics
NPI:1124140751
Name:THOUSAND OAKS CHILDRENS DENTAL GROUP
Entity type:Organization
Organization Name:THOUSAND OAKS CHILDRENS DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:AHSAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:RAZA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:805-497-3797
Mailing Address - Street 1:61 LONG CT
Mailing Address - Street 2:SUITE 202
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360
Mailing Address - Country:US
Mailing Address - Phone:805-497-3797
Mailing Address - Fax:805-371-1121
Practice Address - Street 1:61 LONG CT
Practice Address - Street 2:SUITE 202
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360
Practice Address - Country:US
Practice Address - Phone:805-497-3797
Practice Address - Fax:805-371-1121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0360291223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty