Healthcare Provider Details

I. General information

NPI: 1487893798
Provider Name (Legal Business Name): BEHZAD SHIRAZI INC, A PROFESSIONAL DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2009
Last Update Date: 04/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4366 TUJUNGA AVE
STUDIO CITY CA
91604-2751
US

IV. Provider business mailing address

4366 TUJUNGA AVE
STUDIO CITY CA
91604-2751
US

V. Phone/Fax

Practice location:
  • Phone: 818-985-5462
  • Fax: 818-985-2612
Mailing address:
  • Phone: 818-985-5462
  • Fax: 818-985-2612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. BEHZAD SHIRAZI ARDESTANI
Title or Position: OWNER
Credential: DDS
Phone: 818-985-5462