Provider Demographics
NPI:1366530115
Name:N ABHARI DDS PC
Entity type:Organization
Organization Name:N ABHARI DDS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:NADERE
Authorized Official - Middle Name:
Authorized Official - Last Name:ABHARI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS FDS RCS
Authorized Official - Phone:858-270-1400
Mailing Address - Street 1:3023 BUNKER HILL ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109
Mailing Address - Country:US
Mailing Address - Phone:858-270-1400
Mailing Address - Fax:858-270-1424
Practice Address - Street 1:3023 BUNKER HILL ST
Practice Address - Street 2:SUITE 101
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109
Practice Address - Country:US
Practice Address - Phone:858-270-1400
Practice Address - Fax:858-270-1424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40793122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
B4079301Medicare ID - Type Unspecified