Healthcare Provider Details

I. General information

NPI: 1275028342
Provider Name (Legal Business Name): ANAHITA KHORAMSHAHI DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2018
Last Update Date: 06/27/2026
Certification Date: 06/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44770 VALLEY CENTRAL WAY
LANCASTER CA
93536-6527
US

IV. Provider business mailing address

26065 BELLIS DR
SANTA CLARITA CA
91355-2032
US

V. Phone/Fax

Practice location:
  • Phone: 661-499-2210
  • Fax:
Mailing address:
  • Phone: 818-404-0660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7099
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number112673
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: