Individual
BEHTASH ADIBI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
78595 HIGHWAY 111 STE 300, LA QUINTA, CA 92253-2084
(607) 771-0300
Mailing address
250 PASTO RICO # 34, RANCHO SANTA MARGARITA, CA 92688-2902
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
107699
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/07/2021
Last updated
08/05/2022
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