Provider Demographics
NPI:1346303542
Name:SHAWN RABIZADEH DDS INC.
Entity type:Organization
Organization Name:SHAWN RABIZADEH DDS INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:RABIZADEH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-887-0260
Mailing Address - Street 1:21601 VANOWEN ST.
Mailing Address - Street 2:#100
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91303-2752
Mailing Address - Country:US
Mailing Address - Phone:818-887-0260
Mailing Address - Fax:818-716-3122
Practice Address - Street 1:21601 VANOWEN ST.
Practice Address - Street 2:#100
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91303-2752
Practice Address - Country:US
Practice Address - Phone:818-887-0260
Practice Address - Fax:818-716-3122
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHAWN RABIZADEH DDS INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-18
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46324122300000X
CA122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty