Provider Demographics
NPI:1215096250
Name:ARBABI GHABROUDI, MANOUCHEHR (DDS)
Entity type:Individual
Prefix:MR
First Name:MANOUCHEHR
Middle Name:
Last Name:ARBABI GHABROUDI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 SOUTH ELCAMINO REAL
Mailing Address - Street 2:SUITE #2
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402-3019
Mailing Address - Country:US
Mailing Address - Phone:650-357-0707
Mailing Address - Fax:650-357-1717
Practice Address - Street 1:1415 SOUTH ELCAMINO REAL
Practice Address - Street 2:SUITE #2
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402-3019
Practice Address - Country:US
Practice Address - Phone:650-357-0707
Practice Address - Fax:650-357-1717
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26948122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA171993OtherDENTICAL