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General NPI Number Information
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NPI Number | 1285791574
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Entity Type | Individual
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Provider Name | TANIA SHANAZARI D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 01/03/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2028 W PICO BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90006-5011
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Country | US
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Telephone | 213-380-5506
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Fax | 213-380-0754
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Provider Business Mailing Address
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Address Line | 3726 PONTIAC ST
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City | LA CRESCENTA
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State | CA
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Zip | 91214-1734
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Country | US
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Telephone | 818-542-9517
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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 | 54208
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License Number State | CA
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