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General NPI Number Information
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NPI Number | 1841485059
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Entity Type | Organization
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Legal Business Name | HOMA SHAHRIARI DDS INC
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Dates
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Enumeration Date | 09/11/2007
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Last Update Date | 09/11/2007
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Provider Practice Location Address
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Address Line | 8632 BALBOA BLVD
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City | NORTHRIDGE
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State | CA
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Zip | 91325-3505
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Country | US
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Telephone | 818-894-6161
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Fax | 818-894-6001
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Provider Business Mailing Address
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Address Line | 8632 BALBOA BLVD
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City | NORTHRIDGE
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State | CA
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Zip | 91325-3505
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Country | US
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Telephone | 818-894-6161
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Fax | 818-894-6001
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Authorized Official
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Title or Position | OWNER
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Name | DR. HOMA SHAHRIARI
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Credential | D.D.S.
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Telephone | 818-894-6161
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 44258
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License Number State | CA
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