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General NPI Number Information
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NPI Number | 1174872428
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Entity Type | Individual
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Provider Name | GHAZALEH SHAHRIARI AHMADI DDS
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Gender | Female
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Dates
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Enumeration Date | 09/02/2012
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Last Update Date | 09/06/2012
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Provider Practice Location Address
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Address Line | 8110 W 83RD ST APT 1
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City | PLAYA DEL REY
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State | CA
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Zip | 90293-7855
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Country | US
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Telephone | 310-936-3262
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Fax |
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Provider Business Mailing Address
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Address Line | 8110 W 83RD ST APT 1
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City | PLAYA DEL REY
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State | CA
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Zip | 90293-7855
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Country | US
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Telephone | 310-936-3262
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Fax |
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 61449
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License Number State | CA
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