Provider Demographics
NPI:1003957457
Name:H. POURSHIRAZI DMD, INC
Entity Type:Organization
Organization Name:H. POURSHIRAZI DMD, INC
Other - Org Name:SUN CITY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HOMAYOUN
Authorized Official - Middle Name:
Authorized Official - Last Name:POURSHIRAZI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-672-9457
Mailing Address - Street 1:27851 BRADLEY RD
Mailing Address - Street 2:#155
Mailing Address - City:SUN CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92586-2286
Mailing Address - Country:US
Mailing Address - Phone:951-672-9457
Mailing Address - Fax:951-672-7878
Practice Address - Street 1:27851 BRADLEY RD STE 155
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:CA
Practice Address - Zip Code:92586-2244
Practice Address - Country:US
Practice Address - Phone:951-672-9457
Practice Address - Fax:951-672-7878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2009-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA440641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty