=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396926861
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | E SHIRAZI DDS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/26/2007
-----------------------------------------------------
Last Update Date | 11/26/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2222 EAST ST SUITE 270
-----------------------------------------------------
City | CONCORD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94520-2084
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-689-3500
-----------------------------------------------------
Fax | 925-689-3535
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2222 EAST ST SUITE 270
-----------------------------------------------------
City | CONCORD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94520-2084
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-689-3500
-----------------------------------------------------
Fax | 925-689-3535
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST
-----------------------------------------------------
Name | DR. ELHAM SHIRAZI
-----------------------------------------------------
Credential | D.D.S
-----------------------------------------------------
Telephone | 925-689-3500
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 54211
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------