Provider Demographics
NPI:1083710289
Name:NOORVASH, SEAN (DDS MS)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:NOORVASH
Suffix:
Gender:M
Credentials:DDS MS
Other - Prefix:
Other - First Name:SHAHAB
Other - Middle Name:
Other - Last Name:NOORVASH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS MS
Mailing Address - Street 1:1820 FULLERTON AVE
Mailing Address - Street 2:#220
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92881
Mailing Address - Country:US
Mailing Address - Phone:951-279-2251
Mailing Address - Fax:951-279-5607
Practice Address - Street 1:1820 FULLERTON AVE
Practice Address - Street 2:#220
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92881
Practice Address - Country:US
Practice Address - Phone:951-279-2251
Practice Address - Fax:951-279-5607
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA358961223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics