Provider Demographics
NPI:1487499398
Name:TAGHAVI SHEIKH, OMID (DDS)
Entity type:Individual
Prefix:DR
First Name:OMID
Middle Name:
Last Name:TAGHAVI SHEIKH
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 1:1931 MALCOLM AVE APT 203
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-7603
Mailing Address - Country:US
Mailing Address - Phone:310-467-8992
Mailing Address - Fax:
Practice Address - Street 1:5800 SANTA ROSA RD STE 101
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93012-7060
Practice Address - Country:US
Practice Address - Phone:805-987-8782
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-01
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS1101911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice