| |
3180 Willow Ln Ste 208 Thousand Oaks CA 91361-4988 | |
(805) 230-1900 | |
(805) 230-1912 |
Full Name | |
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Speciality | Dentist - General Practice |
Location | 3180 Willow Ln Ste 208, Thousand Oaks, California |
Authorized Official Name and Position | Farid Tebyani (PRESIDENT/OWNER) |
Authorized Official Contact | 8053008110 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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3180 Willow Ln Ste 208 Thousand Oaks CA 91361-4988 Ph: (805) 230-1900 | 3180 Willow Ln Ste 208 Thousand Oaks CA 91361-4988 Ph: (805) 230-1900 |
NPI Number | 1720520539 |
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Provider Enumeration Date | 11/10/2016 |
Last Update Date | 11/10/2016 |
Identifier | Type | State | Issuer |
---|---|---|---|
1720520539 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
122300000X | Dentist | 53485 (California) | Secondary |
1223G0001X | Dentist - General Practice | 53485 (California) | Primary |
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