Provider Demographics
NPI:1093136145
Name:SHIRVANI, MICHAEL DENTAL CORPORATION
Entity Type:Organization
Organization Name:SHIRVANI, MICHAEL DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIRVANI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-326-4684
Mailing Address - Street 1:8654 FOOTHILL BLVD
Mailing Address - Street 2:#B
Mailing Address - City:SUNLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91040-1911
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8654 FOOTHILL BLVD
Practice Address - Street 2:#B
Practice Address - City:SUNLAND
Practice Address - State:CA
Practice Address - Zip Code:91040-1911
Practice Address - Country:US
Practice Address - Phone:818-951-7299
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-16
Last Update Date:2013-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49995122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty