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General NPI Number Information
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NPI Number | 1124494430
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Entity Type | Organization
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Legal Business Name | SHAHRIARI D D S INC
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Dates
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Enumeration Date | 08/20/2015
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Last Update Date | 08/20/2015
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Provider Practice Location Address
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Address Line | 15840 VENTURA BLVD SUITE 211
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City | ENCINO
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State | CA
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Zip | 91436-2932
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Country | US
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Telephone | 818-906-3838
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Fax |
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Provider Business Mailing Address
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Address Line | 15840 VENTURA BLVD SUITE 211
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City | ENCINO
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State | CA
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Zip | 91436-2932
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Country | US
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Telephone | 818-906-3838
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | HOMA SHAHRIARI
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Credential | DDS
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Telephone | 818-906-3838
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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 | 44250
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License Number State | CA
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