Provider Demographics
NPI:1013402262
Name:DADASHZADEH, ARYA TIU (DDS)
Entity Type:Individual
Prefix:DR
First Name:ARYA
Middle Name:TIU
Last Name:DADASHZADEH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 CENTAURUS
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92603-5717
Mailing Address - Country:US
Mailing Address - Phone:714-469-1687
Mailing Address - Fax:
Practice Address - Street 1:95-1099 AINAMAKUA DR STE 3
Practice Address - Street 2:
Practice Address - City:MILILANI
Practice Address - State:HI
Practice Address - Zip Code:96789-4298
Practice Address - Country:US
Practice Address - Phone:808-623-2871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-28
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT-29281223G0001X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty