Healthcare Provider Details

I. General information

NPI: 1518081439
Provider Name (Legal Business Name): HAMID R SHIRAZI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 F ST STE 5
DAVIS CA
95616-3738
US

IV. Provider business mailing address

750 F ST STE 5
DAVIS CA
95616-3738
US

V. Phone/Fax

Practice location:
  • Phone: 530-756-6087
  • Fax: 530-756-5688
Mailing address:
  • Phone: 530-756-6087
  • Fax: 530-756-5688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number43075
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: