Healthcare Provider Details

I. General information

NPI: 1528243482
Provider Name (Legal Business Name): AFSHIN DOWLATSHAHI D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2008
Last Update Date: 01/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24863 W JAYNE AVENUE
COALINGA CA
93210
US

IV. Provider business mailing address

PO BOX 49867
LOS ANGELES CA
90049-0867
US

V. Phone/Fax

Practice location:
  • Phone: 559-935-4900
  • Fax:
Mailing address:
  • Phone: 310-471-7726
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number54248
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: