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General NPI Number Information
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NPI Number | 1164646469
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Entity Type | Individual
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Provider Name | ALLAHYAR J SHIRVAN DDS
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Gender | Male
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Dates
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Enumeration Date | 04/11/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 5635 STRATFORD CIR STE C36
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City | STOCKTON
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State | CA
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Zip | 95207-5069
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Country | US
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Telephone | 209-473-1010
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Fax | 209-473-3805
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Provider Business Mailing Address
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Address Line | 5635 STRATFORD CIR STE C36
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City | STOCKTON
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State | CA
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Zip | 95207-5069
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Country | US
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Telephone | 209-473-1010
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Fax | 209-473-3805
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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 | 39708
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License Number State | CA
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