Provider Demographics
NPI:1093974255
Name:BANIHASHEMI, SHAHRIYAR (DDS)
Entity Type:Individual
Prefix:
First Name:SHAHRIYAR
Middle Name:
Last Name:BANIHASHEMI
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 1:10116 RIVERSIDE DR
Mailing Address - Street 2:SUITE 301
Mailing Address - City:TOLUCA LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:91602-2563
Mailing Address - Country:US
Mailing Address - Phone:818-766-6126
Mailing Address - Fax:818-766-0730
Practice Address - Street 1:10116 RIVERSIDE DR
Practice Address - Street 2:SUITE 301
Practice Address - City:TOLUCA LAKE
Practice Address - State:CA
Practice Address - Zip Code:91602-2563
Practice Address - Country:US
Practice Address - Phone:818-766-6126
Practice Address - Fax:818-766-0730
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-03
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA360501223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics