Provider Demographics
NPI:1306383096
Name:JAVID DENTAL PC
Entity type:Organization
Organization Name:JAVID DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:MR
Authorized Official - First Name:SHAHIN
Authorized Official - Middle Name:
Authorized Official - Last Name:JAVID
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-222-2242
Mailing Address - Street 1:27335 TOURNEY RD SUITE 100
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-2200
Mailing Address - Country:US
Mailing Address - Phone:661-222-2242
Mailing Address - Fax:661-222-2236
Practice Address - Street 1:27335 TOURNEY RD SUITE 100
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-2200
Practice Address - Country:US
Practice Address - Phone:661-222-2242
Practice Address - Fax:661-222-2236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-19
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43021261QD0000X
122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherDELTA DENTAL