Individual
MICAH TABANFAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
4404 NOGALES DR, TARZANA, CA 91356-5120
(818) 708-1622
Mailing address
4404 NOGALES DR, TARZANA, CA 91356-5120
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
106010
CA
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
106010
CA
Other
Enumeration date
02/24/2021
Last updated
06/12/2023
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