Provider Demographics
NPI:1003255852
Name:SOHRAB MOSHIRI, DDS INC
Entity Type:Organization
Organization Name:SOHRAB MOSHIRI, DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SOHRAB
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSHIRI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, PS
Authorized Official - Phone:818-518-5020
Mailing Address - Street 1:23111 VENTURA BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-1103
Mailing Address - Country:US
Mailing Address - Phone:818-518-5020
Mailing Address - Fax:818-222-2588
Practice Address - Street 1:23111 VENTURA BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-1103
Practice Address - Country:US
Practice Address - Phone:818-518-5020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-14
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA535221223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty