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General NPI Number Information
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NPI Number | 1205291671
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Entity Type | Individual
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Provider Name | NIOSHA VAKILIAN DDS
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Gender | Female
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Dates
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Enumeration Date | 12/29/2015
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Last Update Date | 08/01/2022
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Provider Practice Location Address
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Address Line | 18450 DEARBORN ST
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City | NORTHRIDGE
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State | CA
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Zip | 91325-2259
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Country | US
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Telephone | 818-736-9339
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Fax |
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Provider Business Mailing Address
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Address Line | 19737 CRYSTAL HILLS LN
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City | NORTHRIDGE
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State | CA
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Zip | 91326
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Country | US
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Telephone | 818-876-2947
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 33764
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 64688
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License Number State | CA
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