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General NPI Number Information
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NPI Number | 1508045790
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Entity Type | Organization
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Legal Business Name | TMJ AND SLEEP THERAPY CENTRE OF CONEJO VALLEY
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Dates
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Enumeration Date | 10/24/2007
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Last Update Date | 07/15/2011
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Provider Practice Location Address
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Address Line | 558 SAINT CHARLES DR # 201
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City | THOUSAND OAKS
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State | CA
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Zip | 91360-3903
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Country | US
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Telephone | 805-496-5700
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Fax | 805-496-5719
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Provider Business Mailing Address
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Address Line | 558 SAINT CHARLES DR # 201
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City | THOUSAND OAKS
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State | CA
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Zip | 91360-3903
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Country | US
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Telephone | 805-496-5700
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Fax | 805-496-5719
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. DAVID ESMAIL SHIRAZI
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Credential | D.D.S.
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Telephone | 805-496-5700
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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 | DDS48020
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License Number State | CA
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