Provider Demographics
NPI:1316183304
Name:TAYARANI BABAI, MAHNAZ (RDHAP)
Entity type:Individual
Prefix:MS
First Name:MAHNAZ
Middle Name:
Last Name:TAYARANI BABAI
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3
Mailing Address - Street 2:
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94942-0003
Mailing Address - Country:US
Mailing Address - Phone:415-813-1436
Mailing Address - Fax:
Practice Address - Street 1:1220 SHELTER BAY AVE
Practice Address - Street 2:
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-3020
Practice Address - Country:US
Practice Address - Phone:510-501-7630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-23
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA388124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist