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General NPI Number Information
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NPI Number | 1831250208
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Entity Type | Organization
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Legal Business Name | AFSHIN MAZDEYASNAN DDS A PROF DENTAL CORP
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Dates
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Enumeration Date | 12/12/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 18250 ROSCOE BLVD SUITE 345
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City | NORTHRIDGE
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State | CA
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Zip | 91325
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Country | US
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Telephone | 818-885-3636
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Fax | 818-885-1236
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Provider Business Mailing Address
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Address Line | 18250 ROSCOE BLVD SUITE 345
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City | NORTHRIDGE
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State | CA
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Zip | 91325
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Country | US
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Telephone | 818-885-3636
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Fax | 818-885-1236
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Authorized Official
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Title or Position | PRINCIPLE OFFICER PRESIDENT
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Name | DR. AFSHIN MAZDEYASNAN
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Credential | DDS
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Telephone | 818-885-3636
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number |
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License Number State |
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