MEDICARE: DR. SHEIDA MOHAMMADIZADEH D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	49781	CA

General Provider Information

NPI Number	:	1053300574
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHEIDA MOHAMMADIZADEH D.D.S.

Provider Business Mailing Address
First Line	:	19348 VAN BUREN BLVD
Second Line	:	STE#117
City	:	RIVERSIDE
State	:	CA
Zip	:	92508-9157
Country	:	US
Telephone Number	:	951-789-9905
Fax Number	:	951-789-9906

Provider Business Practice Location Address
First Line	:	19348 VAN BUREN BLVD
Second Line	:	STE#117
City	:	RIVERSIDE
State	:	CA
Zip	:	92508-9157
Country	:	US
Telephone Number	:	951-789-9905
Fax Number	:	951-789-9906

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2005
Last Update Date	:	01/10/2020

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