Provider Demographics
NPI:1346081783
Name:ABRISHAMI DENTAL PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:ABRISHAMI DENTAL PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BABAK
Authorized Official - Middle Name:
Authorized Official - Last Name:ABRISHAMI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-435-5537
Mailing Address - Street 1:302 E CARSON AVE FL 10
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89101-5905
Mailing Address - Country:US
Mailing Address - Phone:310-435-5537
Mailing Address - Fax:
Practice Address - Street 1:302 E CARSON AVE FL 10
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89101-5905
Practice Address - Country:US
Practice Address - Phone:310-435-5537
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-31
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty