MEDICARE: SHAHEN ROSTAMIAN DDS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1275038317
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHAHEN ROSTAMIAN DDS INC

Provider Business Mailing Address
First Line	:	22554 VENTURA BLVD STE 135
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91364-1434
Country	:	US
Telephone Number	:	818-224-4224
Fax Number	:	818-224-4442

Provider Business Practice Location Address
First Line	:	8120 FOOTHILL BLVD
Second Line	:
City	:	SUNLAND
State	:	CA
Zip	:	91040-2941
Country	:	US
Telephone Number	:	818-224-4224
Fax Number	:	818-224-4442

Authorized Official
Title or Position	:	OWNER
Name	:	SHAHEN ROSTAMIAN
Credential	:	DDS
Telephone Number	:	818-224-4224

Provider Enumeration Date	:	03/29/2018
Last Update Date	:	09/25/2020

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