Provider Demographics
NPI:1447316864
Name:HEIDARI, BABAK (DDS, MPH,)
Entity type:Individual
Prefix:DR
First Name:BABAK
Middle Name:
Last Name:HEIDARI
Suffix:
Gender:M
Credentials:DDS, MPH,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:980 N TUSTIN ST
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92867-5903
Mailing Address - Country:US
Mailing Address - Phone:714-997-1005
Mailing Address - Fax:714-997-1055
Practice Address - Street 1:980 N TUSTIN ST
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92867-5903
Practice Address - Country:US
Practice Address - Phone:714-997-1005
Practice Address - Fax:714-997-1055
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2011-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA546001223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health