Provider Demographics
NPI:1003182619
Name:DEHGHAN SHIRAZI, LEYLI (DDS)
Entity Type:Individual
Prefix:DR
First Name:LEYLI
Middle Name:
Last Name:DEHGHAN SHIRAZI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:436 N ROXBURY DR STE 109
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-5016
Mailing Address - Country:US
Mailing Address - Phone:310-385-1311
Mailing Address - Fax:310-385-1377
Practice Address - Street 1:436 N ROXBURY DR STE 109
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-5016
Practice Address - Country:US
Practice Address - Phone:310-385-1311
Practice Address - Fax:310-385-1377
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-28
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA513341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice