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General NPI Number Information
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NPI Number | 1053300574
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Entity Type | Individual
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Provider Name | SHEIDA MOHAMMADIZADEH D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 10/18/2005
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Last Update Date | 01/10/2020
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Provider Practice Location Address
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Address Line | 19348 VAN BUREN BLVD STE#117
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City | RIVERSIDE
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State | CA
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Zip | 92508-9157
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Country | US
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Telephone | 951-789-9905
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Fax | 951-789-9906
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Provider Business Mailing Address
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Address Line | 19348 VAN BUREN BLVD STE#117
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City | RIVERSIDE
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State | CA
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Zip | 92508-9157
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Country | US
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Telephone | 951-789-9905
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Fax | 951-789-9906
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 49781
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License Number State | CA
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