Provider Demographics
NPI:1053300574
Name:MOHAMMADIZADEH, SHEIDA (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHEIDA
Middle Name:
Last Name:MOHAMMADIZADEH
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 1:19348 VAN BUREN BLVD
Mailing Address - Street 2:STE#117
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92508-9157
Mailing Address - Country:US
Mailing Address - Phone:951-789-9905
Mailing Address - Fax:951-789-9906
Practice Address - Street 1:19348 VAN BUREN BLVD
Practice Address - Street 2:STE#117
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92508-9157
Practice Address - Country:US
Practice Address - Phone:951-789-9905
Practice Address - Fax:951-789-9906
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-18
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA497811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice