Provider Demographics
NPI:1174073704
Name:KABIRI, AZITA (DDS)
Entity type:Individual
Prefix:
First Name:AZITA
Middle Name:
Last Name:KABIRI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4284 DIAVILA AVE
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-8373
Mailing Address - Country:US
Mailing Address - Phone:925-206-0735
Mailing Address - Fax:
Practice Address - Street 1:4284 DIAVILA AVE
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-8373
Practice Address - Country:US
Practice Address - Phone:925-206-0735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-06
Last Update Date:2017-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS100543122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist