# RAMIN SHABTAIE, DDS, INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1811181977
- **Authorized official:** DR. RAMIN SHABTAIE DDS (OWNER/PRESIDENT)
- **Authorized official phone:** (310) 208-3471

## Contact information

- **Practice address:** 10921 WILSHIRE BLVD, SUITE 608, LOS ANGELES, CA 90024-3906
- **Practice address phone:** (310) 208-3471
- **Practice address fax:** (310) 208-2553
- **Mailing address:** 10921 WILSHIRE BLVD, SUITE 608, LOS ANGELES, CA 90024-3906
- **Mailing address phone:** (310) 208-3471
- **Mailing address fax:** (310) 208-2553

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 43561 | CA | Yes |

## Other

- **Enumeration date:** 08/31/2007
- **Last updated:** 08/31/2007