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General NPI Number Information
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NPI Number | 1093136145
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Entity Type | Organization
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Legal Business Name | SHIRVANI, MICHAEL DENTAL CORPORATION
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Dates
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Enumeration Date | 12/16/2013
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Last Update Date | 12/16/2013
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Provider Practice Location Address
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Address Line | 8654 FOOTHILL BLVD #B
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City | SUNLAND
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State | CA
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Zip | 91040-1911
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Country | US
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Telephone | 818-951-7299
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Fax |
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Provider Business Mailing Address
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Address Line | 8654 FOOTHILL BLVD #B
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City | SUNLAND
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State | CA
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Zip | 91040-1911
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHAEL SHIRVANI
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Credential | DDS
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Telephone | 818-326-4684
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 49995
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License Number State | CA
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