Provider Demographics
NPI:1073927935
Name:GHEIDARPOUR, PARISA (DDS)
Entity Type:Individual
Prefix:DR
First Name:PARISA
Middle Name:
Last Name:GHEIDARPOUR
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 1:8599 HAVEN AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-4849
Mailing Address - Country:US
Mailing Address - Phone:909-254-7032
Mailing Address - Fax:909-948-5474
Practice Address - Street 1:8599 HAVEN AVE STE 105
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-4849
Practice Address - Country:US
Practice Address - Phone:909-945-2342
Practice Address - Fax:909-948-5474
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-18
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63475122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist