Healthcare Provider Details

I. General information

NPI: 1184760852
Provider Name (Legal Business Name): DANNY SHIRI D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 02/26/2020
Certification Date: 02/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6320 COMMODORE SLOAT DR
LOS ANGELES CA
90048-5444
US

IV. Provider business mailing address

6310 SAN VICENTE BLVD STE 295
LOS ANGELES CA
90048-5454
US

V. Phone/Fax

Practice location:
  • Phone: 323-936-9102
  • Fax:
Mailing address:
  • Phone: 323-936-9102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number35451
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number35451
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: